| Source: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#supportive Established Guidelines Support Potential for NK-1 Market Growth HIGH EMETIC RISK INTRAVENOUS CHEMOTHERAPY – ACUTE AND DELAYED EMESIS PREVENTIONa,b,c Start before chemotherapyc,d Serotonin (5-HT3) antagonist:e,f Dolasetron 100mg POg or Granisetron 2mg PO or 1mg PO BID or 0.01mg/kg (max 1mg) IV day 1g or transdermal patch as 3.1mg/24 h patch (containing 34.3mg granisetron total dose) applied approximately 24-48 h prior to first dose of chemotherapy; maximum duration of patch is 7 days or Ondansetron 16-24mg PO or 8-16mg (max 32mg/day) IV day 1g,h or Palonosetron 0.25mg IV day 1 (preferred)i AND Steroid:j Dexamethasone 12mg PO or IV day 1, 8mg PO daily days 2-4 (with aprepitant 125mg) or Dexamethasone 12mg PO or IV day 1, 8mg PO day 2, then 8mg PO BID days 3 and 4 (with fosaprepitant 150mg IV day 1) AND Neurokinin 1 antagonist: Aprepitant 125mg PO day 1, 80mg PO daily days 2-3 or Fosaprepitant 150mg IV day 1 only or ± Lorazepam 0.5-2mg PO or IV or sublingual either every 4 hours or every 6 hours days 1-4 ± H2 blocker or proton pump inhibitor NCCN Guidelines® Version 1.2013 Antiemesis ® Emetogenic Potential of Intravenous Antineoplastic AgentsV Level Agent High emetic risk (>90% frequency of emesis)s,t AC combination defined as either doxorubicin or epirubicin with cyclophosphamide s Carmustine >250mg/m2 Cisplatin Cyclophosphamide >1,500mg/m2 Dacarbazine Doxorubicin >60mg/m2 Epirubicin >90mg/m2 Ifosfamide >2g/m2 per dose Mechlorethamine Streptozocin Moderate Emetic Risk Intravenous Chemotherapy – Emesis Preventionb,c,k As per high emetic risk prevention, aprepitant should be added (to dexamethasone and a 5-HT3 antagonist regimen) for select patients receiving other chemotherapies of moderate emetic risk (e.g., carboplatin, doxorubicin, epirubicin, ifosfamide, irinotecan, methotrexate) (See AE-2) |