A systematic review and meta-analysis of intravenous palonosetron in the prevention of chemotherapy-induced nausea and vomiting in adults.

Abstract

OBJECTIVES:

We performed a systematic review and meta-analysis to compare treatment effectiveness and adverse effects in cancer patients receiving chemotherapy with palonosetron to prevent chemotherapy-induced nausea and vomiting (CINV).

METHODS:

We identified randomized controlled clinical trials (RCT) comparing palonosetron with first-generation 5-HT3RA in the prevention of CINV in cancer patients. Meta-analyses were performed on homogeneous studies. Fixed or random-effects models were used to combine data.

RESULTS:

Eight eligible trials were identified, reporting outcomes on 3,592 patients. Meta-analyses showed statistically significant differences in favor of palonosetron compared with first-generation 5-HT3RA in prevention of acute CINV (p = .0003), delayed CINV (p < .00001), and overall phase of CINV (p < .00001). Subgroup analyses showed statistically significant differences in favor of both 0.25 mg and 0.75 mg of palonosetron in prevention of all phases of CINV. There were no statistically significant differences between 0.25 and 0.75 mg of palonosetron. Compared with the first-generation 5-HT3RA, 0.75 mg of palonosetron showed a statistically significant difference in the occurrence of constipation (p = .04).

INTERPRETATION:

The use of palonosetron should be considered an integral part of adjuvant therapy for prevention of the acute, delayed, and overall phases of CINV. The 0.25 mg intravenous palonosetron dose is as effective as the 0.75 mg intravenous palonosetron dose. However, 0.75 mg intravenous palonosetron causes constipation more frequently than the first-generation 5-HT3RA.

• Authors: Zhou Likun, Jing Xiang, Ba Yi, Duan Xin, Zheng Liu Tao
• Journal: The oncologist (Oncologist) Vol. 16 Issue 2 Pg. 207-16 ( 2011) ISSN: 1549-490X [Electronic] England
• PMID: 21282670 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)

Chemical References

• Antiemetics
• Antineoplastic Agents
• Isoquinolines
• Quinuclidines
• Serotonin 5-HT3 Receptor Antagonists
• Palonosetron
• Dexamethasone

Topics

• Adult
• Antiemetics (adverse effects, therapeutic use)
• Antineoplastic Agents (adverse effects, therapeutic use)
• Constipation (chemically induced)
• Dexamethasone (adverse effects, therapeutic use)
• Headache (chemically induced)
• Humans
• Infusions, Intravenous
• Isoquinolines (adverse effects, therapeutic use)
• Nausea (chemically induced, drug therapy, prevention & control)
• Neoplasms (drug therapy)
• Palonosetron
• Quinuclidines (adverse effects, therapeutic use)
• Serotonin 5-HT3 Receptor Antagonists (adverse effects, therapeutic use)
• Treatment Outcome
• Vomiting (chemically induced, drug therapy, prevention & control)