Supportive Care in Cancer

, Volume 19, Issue 6, pp 823–832 | Cite as

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

  • Tobias Engel Ayer Botrel
  • Otávio Augusto C. Clark
  • Luciana Clark
  • Luciano Paladini
  • Enéas Faleiros
  • Bruna Pegoretti
Original Article



The objective of this work is to perform a systematic review and meta-analysis of all randomized controlled trials comparing a single intravenous dose of palonosetron (PAL) 0.25 mg with other 5-HT3R in patients receiving moderately or highly emetogenic (MoHE) chemotherapy.


Several databases were searched, including MEDLINE, EMBASE, LILACS, and CENTRAL. The primary endpoints were the incidence of acute and delayed nausea and vomiting. The side effects of each treatment were analyzed. A subgroup analysis was performed to evaluate the influence of the use of corticosteroids. The results are expressed as risk ratio (RR) and the correspondent 95% confidence interval (CI).


Five studies were included, with 2,057 patients. PAL was compared with ondansetron, granisetron, and dolasetron. Patients in PAL group had less nausea, both acute (RR = 0.86; CI95% = 0.76 to 0.96; p = 0.007) and delayed (RR = 0.82; CI95% = 0.75 to 0.89; p < 0.00001). They also had less acute vomiting (RR = 0.76; CI95% = 0.66 to 0.88; p = 0.0002) and delayed vomiting (RR = 0.76; CI95% = 0.68 to 0.85; p < 0.00001). There were no statistical differences in side effects like headache (RR = 0.84; CI95% = 0.61 to 1.17; p = 0.30), dizziness (RR = 0.40; CI95% = 0.13 to 1.27; p = 0.12), constipation (RR = 1.29; CI95% = 0.77 to 2.17; p = 0.33) or diarrhea (RR = 0.67; CI95% = 0.24 to 1.85; p = 0.44). Patients receiving PAL presented less nausea and vomiting regardless of the use of corticoids. We found no statistical heterogeneity in the global analysis.


PAL was more effective than the other 5-HT3R in preventing acute and delayed CINV in patients receiving MoHE treatments, regardless of the use of concomitant corticosteroids.


Chemotherapy Nausea Vomiting Palonosetron Meta-analysis 


Conflict of interest

This study was partially financed by Schering-Plough of Brazil.

Otávio Augusto C. Clark, Tobias Engel Ayer Botrel, received unrestricted educational grants from Schering-Plough of Brazil in the last years.


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Tobias Engel Ayer Botrel
    • 1
  • Otávio Augusto C. Clark
    • 1
  • Luciana Clark
    • 1
  • Luciano Paladini
    • 1
  • Enéas Faleiros
    • 1
  • Bruna Pegoretti
    • 1
  1. 1.Rua Tranquillo Prosperi, 143São PauloBrazil

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