Rolapitant as an Antiemetic in Malignant Glioma Patients Receiving Radiotherapy and Temozolomide

Inclusion Criteria

• Patients must have histologically-confirmed, newly-diagnosed malignant glioma (glioblastoma, gliosarcoma, anaplastic astrocytoma, anaplastic oligoastrocytoma, anaplastic pleomorphic xanthoastrocytoma, or anaplastic oligodendroglioma) and are scheduled to receive radiotherapy (for a total of 54-60 Gy) and concomitant daily temozolomide therapy (at a dose of 75 mg/m^2 for one complete 6-week cycle).
• Age ≥ 18 years
• Karnofsky ≥ 60% or ECOG 0-2
• Hematocrit >29%, Absolute Neutrophil Count >1,000 cells/mm^3, platelets >100,000 cells/mm^3
• Serum creatinine <1.4 mg/dl, bilirubin <1.5 times upper limit of normal (ULN)
• Aspartate aminotransferase (AST) ≤ 2.5 x ULN. For subjects with known liver metastases ≤ 5 x ULN, and alanine aminotransferase (ALT) ≤ 2.5 x ULN. For subjects with known liver metastases ≤ 5 x ULN
• For patients on higher than physiological level of corticosteroids, they must have been on a stable dose for 1 week prior to initiating study drug, and the dose should not be escalated over entry dose level, if clinically possible
• Ability and willingness to give informed consent
• Female patients of childbearing potential must have a negative pregnancy test at Screening
• Female patients of childbearing potential must agree to use an acceptable method of birth control from the signing of informed consent and to continue its use during the study and for at least 90 days after the final dose
• Male patients must agree to use an acceptable form of birth control from study Day 1 through at least 90 days after the final dose

Exclusion Criteria

• Co-medications that may interact with rolapitant as reviewed by Duke Preston Robert Tisch Brain Tumor investigator pharmacist.
• Co-medications that are contraindicated in patients on rolapitant including pimozide, thioridazine, carbamazepine, colchicine, dabigatran (Pradaxa), edoxaban (Savaysa), fosphenytoin, metoprolol, phenobarbital, phenytoin, primidone, and warfarin
• Inability or unwillingness to cooperate with the study procedures
• Prophylactic medication for the prevention of nausea and vomiting 24 hours prior to the start of radiation therapy through the full course of radiation therapy is prohibited, with the exception of the study drug. Corticosteroids will be allowed for treatment of cerebral swelling
• Previous participation in any clinical trial involving rolapitant
• Any vomiting, retching, dry heaves, or clinically significant nausea (i.e., NCI Common Toxicity Criteria version 4.0 grade 2-4 nausea) caused by any etiology in the 24 hrs. preceding day 1 of the study intervention (ondansetron or ondansetron with rolapitant) as scheduled to begin on day 1 of radiation and chemotherapy. Or a patient who has a history of anticipatory nausea and vomiting.
• Ongoing vomiting from any organic etiology
• Received rolapitant within 21 days prior to study enrollment
• Prior cancer chemotherapy or radiotherapy
• Any current treatment, medical history, or uncontrolled condition, other than malignancy, (e.g., alcoholism or signs of alcohol abuse, seizure disorder, medical or psychiatric condition) that, in the opinion of the investigator, would confound the results of the study or pose any unwarranted risk in administering study drug to the subject
• Patient has a known hypersensitivity to the administration of rolapitant or its excipients
• Patient has a history of severe renal or hepatic impairment, severe bone marrow suppression, or systemic infection
• Patient is a woman with a positive serum pregnancy test at Screening, is pregnant, breast-feeding, or is planning to conceive children within the projected duration of the study treatment
• Patient has taken the following agents within the last 48 hours prior to the start of treatment with study drug:
• 5-HT3 antagonists (ondansetron, granisetron, dolasetron, tropisetron, etc.).
• Benzamides (metoclopramide, alizapride, etc.)
• Domperidone
• Cannabinoids
• Natural Killer (NK)-1 antagonist (aprepitant)