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Supportive Care in Cancer

, Volume 22, Issue 6, pp 1685–1697 | Cite as

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

  • Marko Popovic
  • David G. Warr
  • Carlo DeAngelis
  • May Tsao
  • Kelvin K. W. Chan
  • Michael Poon
  • Cheryl Yip
  • Natalie Pulenzas
  • Henry Lam
  • Liying Zhang
  • Edward Chow
Review Article

Abstract

Purpose

Palonosetron, a 5-hydroxytryptamine 3 receptor antagonist (5-HT3RA) with a strong binding affinity and long half-life, has been used in numerous trials for the prophylaxis of chemotherapy-induced nausea and vomiting (CINV). We systematically reviewed the efficacy and safety of palonosetron compared to other 5-HT3RAs in CINV prophylaxis.

Methods

A literature search of Ovid MEDLINE, EMBASE, and CENTRAL was conducted to identify randomized controlled trials (RCTs) comparing palonosetron to other 5-HT3RAs in CINV prophylaxis. Primary endpoints were the percentage of patients achieving a complete response (CR), complete control (CC), no emesis, no nausea, or taking no rescue medications. Secondary endpoints were the percentage of patients suffering from 5-HT3RA-related adverse events.

Results

Sixteen RCTs were identified with 2,896 patients randomized to palonosetron and 3,187 patients randomized to other 5-HT3RAs. Palonosetron was consistently statistically superior in CR, CC, no emesis, or no nausea and was sometimes superior in no rescue medication. Subgroup analyses demonstrated similarity in efficacy between highly and moderately emetogenic chemotherapy cohorts. In the acute phase, statistical superiority of palonosetron was found for trials that did not allow dexamethasone; conversely, RCTs that administered dexamethasone to all patients were nonsignificant. Palonosetron was statistically significantly safer in dizziness and mean QTc interval change and similar in constipation, headache, and diarrhea. Clinical superiority of palonosetron was reached in 3 of 19 analyzed efficacy and safety endpoints.

Conclusions

Palonosetron is safer and more efficacious than other 5-HT3RAs. Future antiemetic guidelines should discuss the merits of including palonosetron as a first-line treatment.

Keywords

Palonosetron 5-HT3 receptor antagonist Chemotherapy-induced nausea and vomiting Efficacy Safety 

Notes

Acknowledgments

We thank the generous support of the Bratty Family Fund, Michael and Karyn Goldstein Cancer Research Fund, Joseph and Silvana Melara Cancer Research Fund, and the Ofelia Cancer Research Fund.

Conflict of interest

None.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Marko Popovic
    • 1
  • David G. Warr
    • 2
  • Carlo DeAngelis
    • 3
  • May Tsao
    • 1
  • Kelvin K. W. Chan
    • 4
  • Michael Poon
    • 1
  • Cheryl Yip
    • 1
  • Natalie Pulenzas
    • 1
  • Henry Lam
    • 1
  • Liying Zhang
    • 1
  • Edward Chow
    • 1
  1. 1.Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
  2. 2.Department of Medical Oncology, Princess Margaret Cancer CentreUniversity of TorontoTorontoCanada
  3. 3.Department of Pharmacy, Odette Cancer Centre, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
  4. 4.Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada

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