Skip to main content

Advertisement

SpringerLink
Log in

Effectiveness of palonosetron versus granisetron in preventing chemotherapy-induced nausea and vomiting: a systematic review and meta-analysis

  • Review
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

Chemotherapy-induced nausea and vomiting (CINV) commonly occurs after chemotherapy, adversely affecting patients’ quality of life. Recently, studies have shown inconsistent antiemetic effects of two common 5-hydroxytryptamine 3 receptor antagonists, namely, palonosetron and granisetron. Therefore, we conducted a meta-analysis to evaluate the effectiveness of palonosetron versus granisetron in preventing CINV.

Methods

Relevant studies were obtained from PubMed, Embase, and Cochrane databases. The primary outcome was the complete response (CR) rate. Secondary outcomes were headache and constipation events.

Results

In total, 12 randomized controlled trials and five retrospective studies were reviewed. Palonosetron was consistently statistically superior to granisetron in all phases in terms of the CR rate (acute phases: odds ratio [OR] = 1.28, 95% confidence interval [CI] = 1.06–1.54; delayed phases: OR = 1.38, 95% CI = 1.13–1.69; and overall phases: OR = 1.37, 95% CI = 1.17–1.60). Moreover, a non-significant difference was found between the two groups in terms of the headache event, but the occurrence of the constipation event was lower in the granisetron group than in the palonosetron group.

Conclusion

Palonosetron showed a higher protective efficacy in all phases of CINV prevention, especially in delayed phases, and no relatively severe adverse effects were observed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Availability of data and material

It is not under consideration at another journal. No other papers using the same data set have been published.

Code availability

All data were entered and analyzed using the Review Manager software (version 5.4, Cochrane Collaboration, Oxford, England).

References

  1. Network NCC (2020) Antiemesis (Version 2.2020). https://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf. Accessed 23 April 2020

  2. Osoba D, Zee B, Pater J, Warr D, Latreille J, Kaizer L (1997) Determinants of postchemotherapy nausea and vomiting in patients with cancer. Quality of life and symptom control committees of the national cancer institute of canada clinical trials group. J Clin Oncol 15 (1):116–123. https://doi.org/10.1200/JCO.1997.15.1.116

  3. Hasler WL (1999) Serotonin receptor physiology: relation to emesis. Dig Dis Sci 44(8 Suppl):108S-113S

    CAS  PubMed  Google Scholar 

  4. Jantunen IT, Kataja VV, Muhonen TT (1997) An overview of randomised studies comparing 5-HT3 receptor antagonists to conventional anti-emetics in the prophylaxis of acute chemotherapy-induced vomiting. Eur J Cancer 33(1):66–74. https://doi.org/10.1016/s0959-8049(96)00276-6

    Article  CAS  PubMed  Google Scholar 

  5. Jordan K, Hinke A, Grothey A, Voigt W, Arnold D, Wolf HH, Schmoll HJ (2007) A meta-analysis comparing the efficacy of four 5-HT3-receptor antagonists for acute chemotherapy-induced emesis. Support Care Cancer 15(9):1023–1033. https://doi.org/10.1007/s00520-006-0186-7

    Article  CAS  PubMed  Google Scholar 

  6. Navari RM, Province PS (2006) Emerging drugs for chemotherapy-induced emesis. Expert Opin Emerg Drugs 11(1):137–151. https://doi.org/10.1517/14728214.11.1.137

    Article  CAS  PubMed  Google Scholar 

  7. Stoltz R, Cyong JC, Shah A, Parisi S (2004) Pharmacokinetic and safety evaluation of palonosetron, a 5-hydroxytryptamine-3 receptor antagonist, in U.S. and Japanese healthy subjects. J Clin Pharmacol 44 (5):520–531. https://doi.org/10.1177/0091270004264641

  8. Saito M, Aogi K, Sekine I, Yoshizawa H, Yanagita Y, Sakai H, Inoue K, Kitagawa C, Ogura T, Mitsuhashi S (2009) Palonosetron plus dexamethasone versus granisetron plus dexamethasone for prevention of nausea and vomiting during chemotherapy: a double-blind, double-dummy, randomised, comparative phase III trial. Lancet Oncol 10(2):115–124. https://doi.org/10.1016/s1470-2045(08)70313-9

    Article  CAS  PubMed  Google Scholar 

  9. Aapro MS, Grunberg SM, Manikhas GM, Olivares G, Suarez T, Tjulandin SA, Bertoli LF, Yunus F, Morrica B, Lordick F, Macciocchi A (2006) A phase III, double-blind, randomized trial of palonosetron compared with ondansetron in preventing chemotherapy-induced nausea and vomiting following highly emetogenic chemotherapy. Ann Oncol 17(9):1441–1449. https://doi.org/10.1093/annonc/mdl137

    Article  CAS  PubMed  Google Scholar 

  10. Eisenberg P, Figueroa-Vadillo J, Zamora R, Charu V, Hajdenberg J, Cartmell A, Macciocchi A, Grunberg S, Palonosetron Study G (2003) Improved prevention of moderately emetogenic chemotherapy-induced nausea and vomiting with palonosetron, a pharmacologically novel 5-HT3 receptor antagonist: results of a phase III, single-dose trial versus dolasetron. Cancer 98(11):2473–2482. https://doi.org/10.1002/cncr.11817

    Article  CAS  Google Scholar 

  11. Botrel TE, Clark OA, Clark L, Paladini L, Faleiros E, Pegoretti B (2011) Efficacy of palonosetron (PAL) compared to other serotonin inhibitors (5-HT3R) in preventing chemotherapy-induced nausea and vomiting (CINV) in patients receiving moderately or highly emetogenic (MoHE) treatment: systematic review and meta-analysis. Support Care Cancer 19(6):823–832. https://doi.org/10.1007/s00520-010-0908-8

    Article  PubMed  Google Scholar 

  12. Jin Y, Sun W, Gu D, Yang J, Xu Z, Chen J (2013) Comparative efficacy and safety of palonosetron with the first 5-HT3 receptor antagonists for the chemotherapy-induced nausea and vomiting: a meta-analysis. Eur J Cancer Care (Engl) 22(1):41–50. https://doi.org/10.1111/j.1365-2354.2012.01353.x

    Article  CAS  Google Scholar 

  13. Popovic M, Warr DG, Deangelis C, Tsao M, Chan KK, Poon M, Yip C, Pulenzas N, Lam H, Zhang L, Chow E (2014) Efficacy and safety of palonosetron for the prophylaxis of chemotherapy-induced nausea and vomiting (CINV): a systematic review and meta-analysis of randomized controlled trials. Support Care Cancer 22(6):1685–1697. https://doi.org/10.1007/s00520-014-2175-6

    Article  PubMed  Google Scholar 

  14. van der Vorst MJ, Neefjes EC, Konings IR, Verheul HM (2015) Prophylactic treatment for delayed chemotherapy-induced nausea and vomiting after non-AC based moderately emetogenic chemotherapy: a systematic review of randomized controlled trials. Support Care Cancer 23(8):2499–2506. https://doi.org/10.1007/s00520-015-2778-6

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hesketh PJ, Kris MG, Basch E, Bohlke K, Barbour SY, Clark-Snow RA, Danso MA, Dennis K, Dupuis LL, Dusetzina SB, Eng C, Feyer PC, Jordan K, Noonan K, Sparacio D, Somerfield MR, Lyman GH (2017) Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline update. J Clin Oncol 35(28):3240–3261. https://doi.org/10.1200/JCO.2017.74.4789

    Article  CAS  PubMed  Google Scholar 

  16. Chow R, Warr DG, Navari RM, Tsao M, Popovic M, Chiu L, Milakovic M, Lam H, DeAngelis C (2018) Should palonosetron be a preferred 5-HT3 receptor antagonist for chemotherapy-induced nausea and vomiting? An updated systematic review and meta-analysis. Support Care Cancer 26(8):2519–2549. https://doi.org/10.1007/s00520-018-4237-7

    Article  PubMed  Google Scholar 

  17. Gamble M, Carroll E, Wright GC, Glode AE (2020) Comparison of two different intravenous serotonin antagonists used for chemotherapy-induced nausea and vomiting prophylaxis in patients treated with moderately emetogenic risk regimens: a retrospective analysis from a large academic medical center. J Oncol Pharm Pract:1078155220938847. https://doi.org/10.1177/1078155220938847

  18. Matsumoto K, Takahashi M, Sato K, Osaki A, Takano T, Naito Y, Matsuura K, Aogi K, Fujiwara K, Tamura K, Baba M, Tokunaga S, Hirano G, Imoto S, Miyazaki C, Yanagihara K, Imamura CK, Chiba Y, Saeki T (2020) A double-blind, randomized, multicenter phase 3 study of palonosetron vs granisetron combined with dexamethasone and fosaprepitant to prevent chemotherapy-induced nausea and vomiting in patients with breast cancer receiving anthracycline and cyclophosphamide. Cancer Med 9(10):3319–3327. https://doi.org/10.1002/cam4.2979

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Araz M, Karaagac M, Korkmaz L, Koral L, Inci F, Beypinar I, Uysal M, Artac M (2019) Comparison of palonosetron and granisetron in triplet antiemetic therapy in nonmetastatic breast cancer patients receiving high emetogenic chemotherapy: a multicenter, prospective, and observational study. Cancer Chemother Pharmacol 83(6):1091–1097. https://doi.org/10.1007/s00280-019-03831-4

    Article  CAS  PubMed  Google Scholar 

  20. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods G, Cochrane Statistical Methods G (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928. https://doi.org/10.1136/bmj.d5928

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hrobjartsson A, Kirkham J, Juni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schunemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919. https://doi.org/10.1136/bmj.i4919

    Article  PubMed  PubMed Central  Google Scholar 

  22. McGuinness LA, Higgins JPT (2020) Risk-of-bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods. https://doi.org/10.1002/jrsm.1411

    Article  PubMed  Google Scholar 

  23. GRADEpro GDT (2020) GRADEpro Guideline Development Tool [Software]. McMaster University. (developed by Evidence Prime, Inc.). Available from https://gradepro.org

  24. Common Terminology Criteria for Adverse Events (CTCAE). (2017). https://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_8.5x11.pdf. Accessed 15 Nov 2020

  25. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700. https://doi.org/10.1136/bmj.b2700

    Article  PubMed  PubMed Central  Google Scholar 

  26. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188. https://doi.org/10.1016/0197-2456(86)90046-2

    Article  CAS  PubMed  Google Scholar 

  27. Huang J, Wang XJ, Yu D, Jin YN, Zhen LZ, Xu N, Liu W, Deng YC, Wu SX, He J (2013) The effect of palonosetron hydrochloride in the prevention of chemotherapy-induced moderate and severe nausea and vomiting. Exp Ther Med 5(5):1418–1426. https://doi.org/10.3892/etm.2013.996

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Kimura H, Yamamoto N, Shirai T, Nishida H, Hayashi K, Tanzawa Y, Takeuchi A, Igarashi K, Inatani H, Shimozaki S, Kato T, Aoki Y, Higuchi T, Tsuchiya H (2015) Efficacy of triplet regimen antiemetic therapy for chemotherapy-induced nausea and vomiting (CINV) in bone and soft tissue sarcoma patients receiving highly emetogenic chemotherapy, and an efficacy comparison of single-shot palonosetron and consecutive-day granisetron for CINV in a randomized, single-blinded crossover study. Cancer Med 4(3):333–341. https://doi.org/10.1002/cam4.373

    Article  CAS  PubMed  Google Scholar 

  29. Murakami M, Hashimoto H, Yamaguchi K, Yamaguchi I, Senba S, Siraishi T (2014) Effectiveness of palonosetron for preventing delayed chemotherapy-induced nausea and vomiting following moderately emetogenic chemotherapy in patients with gastrointestinal cancer. Support Care Cancer 22(4):905–909. https://doi.org/10.1007/s00520-013-2046-6

    Article  PubMed  Google Scholar 

  30. Ohzawa H, Miki A, Hozumi Y, Miyazaki C, Sagara Y, Tanaka Y, Shiba S, Joutoku H, Sakuragi M, Takehara M, Sakuma Y, Nishimura W, Fujii H, Yasuda Y (2015) Comparison between the antiemetic effects of palonosetron and granisetron in breast cancer patients treated with anthracycline-based regimens. Oncol Lett 9(1):119–124. https://doi.org/10.3892/ol.2014.2640

    Article  PubMed  Google Scholar 

  31. Raftopoulos H, Cooper W, O’Boyle E, Gabrail N, Boccia R, Gralla RJ (2015) Comparison of an extended-release formulation of granisetron (APF530) versus palonosetron for the prevention of chemotherapy-induced nausea and vomiting associated with moderately or highly emetogenic chemotherapy: results of a prospective, randomized, double-blind, noninferiority phase 3 trial. Support Care Cancer 23(3):723–732. https://doi.org/10.1007/s00520-014-2400-3

    Article  PubMed  Google Scholar 

  32. Roscoe JA, Heckler CE, Morrow GR, Mohile SG, Dakhil SR, Wade JL, Kuebler JP (2012) Prevention of delayed nausea: a University of Rochester Cancer Center Community Clinical Oncology Program study of patients receiving chemotherapy. J Clin Oncol 30(27):3389–3395. https://doi.org/10.1200/JCO.2011.39.8123

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Sato Y, Hayakawa Y, Tatematsu M, Muro K, Noma H, Okamoto H (2012) Antiemetic effect of palonosetron in advanced colorectal cancer patients receiving mFOLFOX6 and FOLFIRI: a retrospective survey. Gan To Kagaku Ryoho 39(8):1215–1219

    PubMed  Google Scholar 

  34. Sayantani Ghosh SD (2010) Comparing different antiemetic regimens for chemotherapy induced nausea and vomiting. International Journal of Collaborative Research on Internal Medicine & Public Health 2(5):142–156

    Google Scholar 

  35. Seol YM, Kim HJ, Choi YJ, Lee EM, Kim YS, Oh SY, Koh SJ, Baek JH, Lee WS, Joo YD, Lee HG, Yun EY, Chung JS (2016) Transdermal granisetron versus palonosetron for prevention of chemotherapy-induced nausea and vomiting following moderately emetogenic chemotherapy: a multicenter, randomized, open-label, cross-over, active-controlled, and phase IV study. Support Care Cancer 24(2):945–952. https://doi.org/10.1007/s00520-015-2865-8

    Article  PubMed  Google Scholar 

  36. Suzuki K, Yamanaka T, Hashimoto H, Shimada Y, Arata K, Matsui R, Goto K, Takiguchi T, Ohyanagi F, Kogure Y, Nogami N, Nakao M, Takeda K, Azuma K, Nagase S, Hayashi T, Fujiwara K, Shimada T, Seki N, Yamamoto N (2016) Randomized, double-blind, phase III trial of palonosetron versus granisetron in the triplet regimen for preventing chemotherapy-induced nausea and vomiting after highly emetogenic chemotherapy: TRIPLE study. Ann Oncol 27(8):1601–1606. https://doi.org/10.1093/annonc/mdw220

    Article  CAS  PubMed  Google Scholar 

  37. Tian W, Wang Z, Zhou J, Zhang S, Wang J, Chen Q, Huang C, Pan L, Zhang L, Huang J, Shen H, Lin T (2011) Randomized, double-blind, crossover study of palonosetron compared with granisetron for the prevention of chemotherapy-induced nausea and vomiting in a Chinese population. Med Oncol 28(1):71–78. https://doi.org/10.1007/s12032-009-9398-2

    Article  CAS  PubMed  Google Scholar 

  38. Uchida M, Mori Y, Nakamura T, Kato K, Kamezaki K, Takenaka K, Shiratsuchi M, Kadoyama K, Miyamoto T, Akashi K (2017) Comparison between antiemetic effects of palonosetron and granisetron on chemotherapy-induced nausea and vomiting in Japanese patients treated with R-CHOP. Biol Pharm Bull 40(9):1499–1505. https://doi.org/10.1248/bpb.b17-00318

    Article  CAS  PubMed  Google Scholar 

  39. Yu Z, Liu W, Wang L, Liang H, Huang Y, Si X, Zhang H, Liu D, Zhang H (2009) The efficacy and safety of palonosetron compared with granisetron in preventing highly emetogenic chemotherapy-induced vomiting in the Chinese cancer patients: a phase II, multicenter, randomized, double-blind, parallel, comparative clinical trial. Support Care Cancer 17(1):99–102. https://doi.org/10.1007/s00520-008-0503-4

    Article  PubMed  Google Scholar 

  40. Ioannidis JP, Hesketh PJ, Lau J (2000) Contribution of dexamethasone to control of chemotherapy-induced nausea and vomiting: a meta-analysis of randomized evidence. J Clin Oncol 18(19):3409–3422. https://doi.org/10.1200/JCO.2000.18.19.3409

    Article  CAS  PubMed  Google Scholar 

  41. The Italian Multicenter Study Group (1999) A double-blind randomized study comparing intramuscular (i.m.) granisetron with i.m. granisetron plus dexamethasone in the prevention of delayed emesis induced by cisplatin. Anti-Cancer Drugs 10(5):465–470

  42. Heron JF, Goedhals L, Jordaan JP, Cunningham J, Cedar E (1994) Oral granisetron alone and in combination with dexamethasone: a double-blind randomized comparison against high-dose metoclopramide plus dexamethasone in prevention of cisplatin-induced emesis. The Granisetron Study Group Ann Oncol 5(7):579–574. https://doi.org/10.1093/oxfordjournals.annonc.a058927

    Article  CAS  Google Scholar 

  43. Italian Group for Antiemetic R (1995) Dexamethasone, granisetron, or both for the prevention of nausea and vomiting during chemotherapy for cancer. N Engl J Med 332(1):1–5. https://doi.org/10.1056/NEJM199501053320101

    Article  Google Scholar 

  44. Okada Y, Oba K, Furukawa N, Kosaka Y, Okita K, Yuki S, Komatsu Y, Celio L, Aapro M (2019) One-day versus three-day dexamethasone in combination with palonosetron for the prevention of chemotherapy-induced nausea and vomiting: a systematic review and individual patient data-based meta-analysis. Oncologist 24(12):1593–1600. https://doi.org/10.1634/theoncologist.2019-0133

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Massaro AM, Lenz KL (2005) Aprepitant: a novel antiemetic for chemotherapy-induced nausea and vomiting. Ann Pharmacother 39(1):77–85. https://doi.org/10.1345/aph.1E242

    Article  CAS  PubMed  Google Scholar 

  46. Jordan K, Warr DG, Hinke A, Sun L, Hesketh PJ (2016) Defining the efficacy of neurokinin-1 receptor antagonists in controlling chemotherapy-induced nausea and vomiting in different emetogenic settings-a meta-analysis. Support Care Cancer 24(5):1941–1954. https://doi.org/10.1007/s00520-015-2990-4

    Article  PubMed  Google Scholar 

  47. Broder MS, Faria C, Powers A, Sunderji J, Cherepanov D (2014) The impact of 5-HT3RA use on cost and utilization in patients with chemotherapy-induced nausea and vomiting: systematic review of the literature. Am Health Drug Benefits 7(3):171–182

    PubMed  PubMed Central  Google Scholar 

  48. Kashiwa M, Matsushita R (2019) Cost-utility analysis of palonosetron in the antiemetic regimen for cisplatin-containing highly emetogenic chemotherapy in Japan. BMC Health Serv Res 19(1):438. https://doi.org/10.1186/s12913-019-4281-0

    Article  PubMed  PubMed Central  Google Scholar 

  49. Shimizu H, Suzuki K, Uchikura T, Tsuji D, Yamanaka T, Hashimoto H, Goto K, Matsui R, Seki N, Shimada T, Ikeda S, Ikegami N, Hama T, Yamamoto N, Sasaki T (2018) Economic analysis of palonosetron versus granisetron in the standard triplet regimen for preventing chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy in Japan (TRIPLE phase III trial). J Pharm Health Care Sci 4:31. https://doi.org/10.1186/s40780-018-0128-9

    Article  PubMed  PubMed Central  Google Scholar 

  50. Schünemann H, Brożek J, Guyatt G, Oxman A, editors (2013) GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013. The GRADE Working Group. Available from guidelinedevelopment.org/handbook

Download references

Acknowledgements

The authors would like to acknowledge Wallace Academic Editing for the assistance in preparing this manuscript for publication from the authors’ original creation.

Author information

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Department of Surgery, En Chu Kong Hospital, New Taipei City, Taiwan

    Yu-Chen Hsu

  2. Department of Pharmacy, En Chu Kong Hospital, 399 Fuxing Road Sanxis District, New Taipei City, 23741, Taiwan

    Ching-Yao Chen & Chin-Yu Hsu

  3. Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    Ka-Wai Tam

  4. Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Ka-Wai Tam

  5. Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan

    Ka-Wai Tam

Authors
  1. Yu-Chen Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ching-Yao Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ka-Wai Tam
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chin-Yu Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Chin-Yu Hsu devised and designed the study. Yu-Chen Hsu, Ching-Yao Chen, and Chin-Yu Hsu extracted the data; Chin-Yu Hsu and Yu-Chen Hsu analyzed and interpreted the data; Yu-Chen Hsu wrote the first draft; Ka-Wai Tam reviewed the first draft and gave comments; all the authors contributed to subsequent versions and approved the final article; Chin-Yu Hsu is the guarantor.

Corresponding author

Correspondence to Chin-Yu Hsu.

Ethics declarations

Consent to participate

All authors have read and approved the manuscript.

Consent for publication

This article has not been published or accepted for publication.

Competing interests

The authors declare no competing interests.

Supplementary information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 599 KB)

Supplementary file2 (DOCX 20 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hsu, YC., Chen, CY., Tam, KW. et al. Effectiveness of palonosetron versus granisetron in preventing chemotherapy-induced nausea and vomiting: a systematic review and meta-analysis. Eur J Clin Pharmacol 77, 1597–1609 (2021). https://doi.org/10.1007/s00228-021-03157-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-021-03157-2

Keywords

Search

Navigation