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fosaprepitant (Focinvez)

✓ Approved

SPES Pharmaceuticals · TACR1 · Small Molecule

What is fosaprepitant?

fosaprepitant is a small molecule developed by SPES Pharmaceuticals. It is approved for therapeutic indications via injectable (others) or intravenous (iv).

Drug Profile

Brand NamesFocinvez
CompanySPES Pharmaceuticals
Drug ClassSmall Molecule
Molecular TargetTACR1
RouteInjectable (Others), Intravenous (IV)
StatusApproved
Sources: ClinicalTrials.gov, SPES Pharmaceuticals

Mechanism of Action

Molecular Targets

fosaprepitant acts on 1 molecular target:

TACR1tachykinin receptor 1 (SPR, TAC1R)
Want deeper analysis?Noah AI can explain complex mechanisms and compare to similar drugs.

Related Research Articles

PubMedSurgical endoscopy2026-09-18

Comparison of aprepitant 80 mg oral, aprepitant 32.4 mg intravenous, and fosaprepitant 75 mg intravenous in the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic sleeve gastrectomy, a retrospective cohort study.

Dahman Mohamed M, Ratermann Craig C, Stuart Faith F, King Kylie K

The most common postoperative (post-op) complication in bariatric surgery is postoperative nausea and vomiting (PONV) with up to 70% of patients reporting symptoms. PONV is also associated with longer post-anesthesia care unit (PACU) time and hospital stays overall. Aprepitant has shown efficacy in reducing PONV and has been added to many standard antiemetic regimens; however, the bioavailability of the oral formulation is not ideal in bariatric surgery patients, and the ideal dose intravenously (IV) has not been established. This retrospective cohort study compared aprepitant 80 mg orally (PO) to aprepitant 32.4 mg intravenous (IV) and fosaprepitant 75 mg IV. The presence of PONV was defined by the number of doses of antiemetics administered postoperatively within four windows: PACU plus 1 h, defined as time upon entry to PACU+1 h, PACU + 12 h, PACU + 24 h, and any further doses administered while admitted thereafter. Secondary outcomes included time to diet ordered, length of hospital stay, and pain control. There was no difference in PONV between aprepitant 80 mg PO vs. 32.4 mg IV vs. fosaprepitant 75 mg in the immediate interim after surgery (PACU + 1 h); however, fosaprepitant was statistically superior to the other two groups at PACU + 12 h, PACU + 24 h, and total doses administered throughout admission. There was no difference in time to diet ordered or pain control, but fosaprepitant was superior when looking at length of stay. In this retrospective cohort, fosaprepitant 75 mg IV was found to be superior overall to aprepitant 32.4 mg IV and 80 mg PO.

PMID 42754628
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PubMedBMJ supportive & palliative care2026-08-28

Cost-effectiveness analysis of fosaprepitant versus aprepitant-based antiemetic regimens in children receiving highly emetogenic chemotherapy: individual patient-level analysis of a randomised trial.

Kumar Rahul R, Sra Manraj Singh MS, Rasheed Azgar Abdul AA, Sasi Archana A et al.

To assess the trial-based cost-effectiveness of an intravenous fosaprepitant-based antiemetic regimen compared with oral aprepitant, in combination with ondansetron and dexamethasone, among children receiving highly emetogenic chemotherapy in India and the USA using individual patient-level data. Costs were estimated from a private payer perspective in India and the USA. Health outcomes were expressed as quality-adjusted life-years (QALYs). Incremental cost-utility ratio (ICUR) and incremental net monetary benefit (iNMB) were calculated. Uncertainty was evaluated through one-way deterministic sensitivity analyses. A total of 140 and 139 children were enrolled in the fosaprepitant and aprepitant groups, respectively. Mean QALYs were marginally higher in the aprepitant group (0.0118 vs 0.0116; difference: 0.0002). In India, mean costs were $33.94 in the fosaprepitant arm vs $19.73 in the aprepitant arm (difference: $14.21). In the USA, mean costs were $615.92 vs $809.73, respectively, in the two arms (difference: $193.81), favouring fosaprepitant. iNMB values of fosaprepitant compared with aprepitant were -$15.59 in India and $173.81 in the USA, indicating lack of cost-effectiveness for fosaprepitant in India but cost-effectiveness in the USA. In sensitivity analyses, the ICUR was most sensitive to the cost of fosaprepitant in India and to the utility value of the complete protection health state in the USA. Intravenous fosaprepitant, administered in combination with ondansetron and dexamethasone, was not cost-effective compared with oral aprepitant-based combination therapy in India but demonstrated cost-effectiveness in the USA.

PMID 42660630
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PubMedJournal of clinical oncology : official journal of the American Society of Clinical Oncology2026-07-31

Dexamethasone-Free Antiemetic Prophylaxis for Children and Adolescents Receiving Highly Emetogenic Chemotherapy: A Multicenter, Phase III, Noninferiority Trial (CIVIC POD).

Radhakrishnan Venkatraman V, Srinivasan Prasanth P, Das Gargi G, Bakhshi Sameer S et al.

Dexamethasone combined with a 5-hydroxytryptamine-3 receptor antagonist and a neurokinin-1 receptor antagonist is the guideline-recommended prophylaxis for chemotherapy-induced nausea and vomiting (CINV) in children receiving highly emetogenic chemotherapy (HEC), but it is associated with clinically relevant toxicities. The role of olanzapine as a dexamethasone-sparing agent for pediatric CINV prophylaxis remains uncertain. The Chemotherapy Induced Vomiting in Children-Prophylaxis Omitting Dexamethasone (CIVIC POD) was an investigator-initiated, multicenter, open-label, phase III, randomized noninferiority (NI) trial (INPHOG-SUPP-22-03) that enrolled patients age 4-18 years scheduled to receive single- or multiday HEC. Patients were randomly assigned 1:1 to dexamethasone, palonosetron, and fosaprepitant (DEX) or olanzapine, palonosetron, and fosaprepitant (OLANZ) for one chemotherapy cycle. The primary end point was complete response (CR) to vomiting (no vomiting and no rescue antiemetics) during the overall period (0-120 h after last chemotherapy). The prespecified NI margin was -15%. A total of 310 patients were randomly assigned (DEX, n = 156; OLANZ, n = 154). The median age was 13 years, 62.3% were male, and 51.9% received multiday chemotherapy. The per-protocol population included 299 patients (DEX, n = 151; OLANZ, n = 148). The overall-period CR to vomiting was 56.9% with DEX and 63.5% with OLANZ (absolute difference, 6.6% [95% CI, -4.5 to 17.7]), meeting NI criteria. Acute-period CR to vomiting was 64.2% versus 68.9%, and delayed-period CR was 78.8% versus 79.1% (DEX v OLANZ). CR to nausea during the overall, acute, and delayed periods was 54.3% versus 53.4%, 59.6% versus 59.5%, and 69.5% versus 68.9%, respectively. Any-grade somnolence was more frequent with OLANZ (50.7% v 17.2%). A dexamethasone-free regimen using olanzapine demonstrated noninferior control of vomiting compared with standard prophylaxis in children and adolescents receiving HEC, supporting olanzapine as a potential corticosteroid-sparing alternative for pediatric CINV prophylaxis.

PMID 42535876
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PubMedCurrent oncology (Toronto, Ont.)2026-07-27

Aprepitant and Fosaprepitant for Preventing Nausea and Vomiting in Patients Receiving Highly Emetogenic Chemotherapy-A Real-World Study.

Ünlü Beyza B, Demir Hacer H, Davarcı Sena Ece SE, Culha Yaşar Y et al.

Chemotherapy-induced nausea and vomiting substantially impair patients' quality of life despite considerable advances in supportive care. Neurokinin-1 receptor antagonists, including oral aprepitant and intravenous fosaprepitant, constitute essential components of antiemetic regimens for highly emetogenic chemotherapy. In this prospective, non-randomized observational study, we compared the efficacy of oral aprepitant and intravenous fosaprepitant administered in combination with 5-hydroxytryptamine-3 receptor antagonists and dexamethasone in 136 chemotherapy-naive patients receiving cisplatin- or doxorubicin-cyclophosphamide-based regimens. Complete response rates during the acute (0-24 h), delayed (24-120 h), and overall (0-120 h) phases were comparable between the two groups, with no statistically significant differences in emesis severity. Multivariable analyses further demonstrated similar effectiveness irrespective of age, sex, or chemotherapy regimen. These findings indicate that no statistically significant differences in antiemetic efficacy were observed between aprepitant and fosaprepitant in routine clinical practice. Fosaprepitant may therefore represent a practical alternative when oral administration is not feasible.

PMID 42505183
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PubMedCancer management and research2026-06-11

Comparative Efficacy of Fosnetupitant and Fosaprepitant for Delayed Vomiting in Patients Receiving Irinotecan-Oxaliplatin Combination Chemotherapy: A Retrospective Propensity Score-Matched Study.

Maeda Kazuki K, Kawada Kei K, Hayashi Toshinobu T, Koyama Sota S et al.

Appropriate prevention of chemotherapy-induced nausea and vomiting (CINV) is essential for improving patients' quality of life; however, no studies have compared neurokinin-1 receptor antagonists in regimens combining oxaliplatin and irinotecan. We aimed to compare the antiemetic efficacy of fosnetupitant and fosaprepitant in patients receiving FOLFIRINOX or FOLFOXIRI regimens. We reviewed records of patients receiving FOLFIRINOX or FOLFOXIRI between April 1, 2018 and September 30, 2024 at Tokushima University Hospital. Eligible patients completed the first chemotherapy cycle, received standard triple antiemetic prophylaxis, and had complete nursing-recorded CINV follow-up data for days 1-7. Patients were matched 1:1 using propensity scores for age, sex, alcohol consumption history, prior treatment, regimen, and chemotherapy doses. The primary objective was to compare the incidence of vomiting during the long-delayed phase (days 6-7) between the fosnetupitant and fosaprepitant groups. The no-vomiting and no-nausea rates were compared using Fisher's exact test, and the time to first vomiting using the Log rank test. After matching, data from 68 balanced patient pairs were analyzed. The fosnetupitant group had higher no-vomiting rates in the long-delayed phase (100% vs. 91.2%, p=0.028) and overall period (95.6% vs. 83.8%, p=0.045), compared with the fosaprepitant group. No significant intergroup difference was observed in the overall no-nausea rate (26.5% vs. 32.3%, p=0.573). With fosnetupitant, the time to first vomiting was longer (3/68 vs. 11/68, hazard ratio: 0.20, p=0.045), injection site reactions were fewer (0.0% vs. 19.1%, p<0.001), and constipation and hiccup incidences were fewer (p>0.05). Despite the retrospective design, possible calendar-time confounding, and limited number of events, our results suggest that fosnetupitant offers better control of long-delayed and overall vomiting and a favorable safety profile, compared with fosaprepitant, in patients receiving FOLFIRINOX/FOLFOXIRI regimens.

PMID 42273006
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PubMedEuropean journal of clinical pharmacology2026-06-10

Efficacy of NEPA for prevention of chemotherapy induced nausea and vomiting in head and neck cancer patients receiving cisplatin-based chemotherapy.

Hwang Tzer-Zen TZ, Wang Chih-Chun CC, Yang Chuan-Chien CC, Lien Ching-Feng CF et al.

A 5-hydroxytryptamine-3 receptor antagonist (5-HT3RA) in combination with a neurokinin-1 receptor antagonist (NK-1RA) are effective for the prevention of chemotherapy induced nausea and vomiting. We investigated the efficacy between oral netupitant and palonosetron (NEPA) and intravenous fosaprepitant and palonosetron (FOPA) in recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) patients treated with cisplatin-based chemotherapy. R/M HNSCC patients who were treated with cisplatin-based chemotherapy as first-line treatment were enrolled in our study. All patients were stratified according to anti-emetic agents, classifying into NEPA group and FOPA group. Anti-emetic efficacy, patients self-report scores and hospitalization days were compared between NEPA and FOPA. A total of 425 R/M HNSCC patients were recruited into our study, with 211 patients in NEPA and 214 patients in FOPA. Anti-emetic efficacy were all significantly better with NEPA than with FOPA across cycle 1 to 5. The mean nausea score were 2.9 vs. 3.4 (p = 0.004) and the mean vomiting score were 1.4 vs. 2.7 (P = 0.001) in cycle 1 for NEPA group and FOPA group, respectively. The mean satisfaction scores were 8.5 vs. 8.2 ( P = 0.032) in cycle1 for NEPA group and FOPA group, respectively. Furthermore, the mean hospitalization days were shorter in NEPA than those in FOPA across cycle 1 to 5, with mean hospitalization days 6.0 versus 7.0 days in cycle 1, respectively. Oral NEPA exhibited a superior anti-emetic efficacy than intravenous FOPA, as well as shorter hospitalization days for R/M HNSCC patients treated with cisplatin-based chemotherapy.

PMID 42268415
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