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Supportive Care in Cancer
Published in: Supportive Care in Cancer 8/2018

01-08-2018 | Review Article

Should palonosetron be a preferred 5-HT3 receptor antagonist for chemotherapy-induced nausea and vomiting? An updated systematic review and meta-analysis

Authors: Ronald Chow, David G. Warr, Rudolph M. Navari, May Tsao, Marko Popovic, Leonard Chiu, Milica Milakovic, Henry Lam, Carlo DeAngelis

Published in: Supportive Care in Cancer | Issue 8/2018

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Abstract

Purpose

Chemotherapy-induced nausea and vomiting (CINV) continues to be a common side effect of systemic anticancer therapy, decreasing quality of life and increasing resource utilization. The aim of this meta-analysis was to investigate the comparative efficacy and safety of palonosetron relative to other 5-HT3RAs.

Methods

A literature search was carried out in Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Full-text references were then screened and included in this meta-analysis if they were an RCT and had adequate data regarding one of the five primary endpoints—complete response (CR), complete control (CC), no emesis, no nausea, or no rescue medications.

Results

A total of 24 RCTs were included in this review. Palonosetron was statistically superior to other 5-HT3RAs for 10 of the 19 assessed endpoints. Only one endpoint—emesis in the overall phase—had noticeable more favorable data for palonosetron to the point that it approached the 10% risk difference (RD) threshold as specified by the MASCC/ESMO antiemetic panel; another two endpoints (CR in the overall phase and nausea in the delayed phase) approached the 10% threshold.

Conclusions

Palonosetron seems to be more efficacious and safe than other 5-HT3RAs—statistically superior in 10 of 19 endpoints. It is, however, only clinically significant in one endpoint and approached clinically significant difference in another two endpoints. Within the limits of this meta-analysis, our results indicate that palonosetron may not be as superior in efficacy and safety as reported in a previous meta-analysis, and supports the recent MASCC/ESMO, ASCO, and NCCN guidelines in not generally indicating palonosetron as the 5-HT3RA of choice.
Appendix
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Metadata
Title
Should palonosetron be a preferred 5-HT3 receptor antagonist for chemotherapy-induced nausea and vomiting? An updated systematic review and meta-analysis
Authors
Ronald Chow
David G. Warr
Rudolph M. Navari
May Tsao
Marko Popovic
Leonard Chiu
Milica Milakovic
Henry Lam
Carlo DeAngelis
Publication date
01-08-2018
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 8/2018
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-018-4237-7

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