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Supportive Care in Cancer
Published in: Supportive Care in Cancer 6/2014

01-06-2014 | Review Article

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

Authors: 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

Published in: Supportive Care in Cancer | Issue 6/2014

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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.
Appendix
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Metadata
Title
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
Authors
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
Publication date
01-06-2014
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 6/2014
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-014-2175-6

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