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A meta-analysis comparing the efficacy of four 5-HT3-receptor antagonists for acute chemotherapy-induced emesis

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Abstract

Goals of work

Comparing antiemetic efficacy of different 5-HT3-receptor antagonists (5-HT3RAs) is difficult due to inter-study variability. Therefore, a meta-analysis was performed to comparatively evaluate dolasetron, granisetron, ondansetron and tropisetron for acute chemotherapy-induced nausea and vomiting (CINV).

Patients and methods

Comparisons between 5-HT3RAs were based on 44 randomized studies (including 12,343 patients) identified by MEDLINE, CANCERLIT or EMBASE searches and subcategorized by chemotherapy type (cisplatin- or non-cisplatin-based).

Main results

When all studies were combined, granisetron was equivalent to ondansetron (n = 27), and showed an advantage vs tropisetron (p = 0.018; n = 12). Ondansetron vs tropisetron (n = 11) and ondansetron vs dolasetron (n = 3) revealed equivalence in each comparison. An advantage for 3 mg granisetron vs 8 mg ondansetron was found in non-cisplatin-based studies (p = 0.015; n = 6). Overall equivalence was seen between ondansetron, 24 or 32 mg, and granisetron, 2 or 3 mg, for all studies (n = 13). There was a possible advantage for higher (24 or 32 mg) vs lower (8 mg) ondansetron dose regimens with cisplatin-based trials (n = 6). No differences were seen between 3 and 1 mg granisetron doses (n = 6).

Conclusions

Efficacy of 5-HT3RAs for preventing CINV following cisplatin- and non-cisplatin-based chemotherapy is comparable, with the exception of granisetron vs tropisetron. Some differences were noted in dosing subanalyses.

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Acknowledgment

This work was supported by an unrestricted grant from Hoffmann-La Roche. The authors would like to thank Jackie Bannister for the assistance in preparing the manuscript.

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Authors and Affiliations

  1. Department for Hematology/Oncology, Martin-Luther University Halle/Wittenberg, Ernst-Grube-Str. 40, 06120, Halle, Germany

    K. Jordan, W. Voigt, D. Arnold, H.-H. Wolf & H.-J. Schmoll

  2. WiSP, Langenfeld, Germany

    A. Hinke

  3. Mayo Clinic, Rochester, MN, USA

    A. Grothey

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  1. K. Jordan
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  2. A. Hinke
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Correspondence to K. Jordan.

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

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