Palonosetron useful for preventing vomiting during chemotherapy

NEW YORK (Reuters Health) - Combined with dexamethasone, palonosetron is comparable to granisetron in preventing chemotherapy-induced nausea and vomiting (CINV) in the acute phase and superior to granisetron in the delayed phase, new research shows.

"This is the first report, to our knowledge, to show the advantage of a single dose of the second-generation 5-HT3-receptor antagonist palonosetron over the first generation 5-HT3-receptor antagonist granisetron in preventing delayed and overall CINV after highly emetogenic chemotherapy," lead author Dr. Mitsue Saito and colleagues state.

The study, reported in the January 8th online issue of The Lancet Oncology, featured 1143 patients who were randomized to receive single-dose palonosetron (0.75 mg) or granisetron (40 micrograms/kg) 30 minutes before treatment. Both groups were given dexamethasone (16 mg intravenously) on day 1, which was followed by additional doses of dexamethasone on days 2 and 3.

The main outcome measures were the proportion of patients with a complete response (no vomiting episodes and no use of rescue medications) during the acute phase (0 to 24 hours after chemotherapy) and delayed phase (24 to 120 hours after chemotherapy), Dr. Saito, from Juntendo University Hospital, Tokyo, and colleagues note.

Palonosetron was deemed non-inferior to granisetron in the acute phase with complete response rates of 75.3% and 73.3%, respectively. During the delayed phase, the complete response rate was significantly higher in the palonosetron group: 56.8% vs. 44.5% (p < 0.0001).

Constipation, the main treatment-related side effect, occurred in 17.4% and 15.7% of palonosetron- and granisetron-treated patients, respectively. Elevated serum aminotransferase levels were less common and occurred with similar frequency in each group. No patients in either group experienced grade 4 treatment-related side effects.

"On the basis of the results of this trial, palonosetron seems to be a safe and effective drug for the prevention of CINV associated with highly emetogenic chemotherapy," the authors conclude.

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