SummaryBackground Palonosetron has demonstrated efficacy in the prevention of chemotherapy-

aim:To investigate across multiple cycles the efficacy and safety of palonosetron in the prevention of chemotherapy-induced nausea and vomiting in pediatric cancer patients receiving highly or moderately emetogenic chemotherapy (HEC/MEC). Patients & methods: Patients were randomly assigned to 10, 20 μg/kg palonosetron or 3 × 150 μg/kg ondansetron for up to four cycles of HEC/MEC. Results: In all on-study chemotherapy cycles, complete response rates were higher in patients in the 20 μg/kg palonosetron group than the ondansetron group. Treatment-emergent adverse events were comparable between the palonosetron 20 μg/kg and ondansetron groups. conclusion: Over four cycles of HEC/ MEC, 20 μg/kg palonosetron was an efficacious and safe treatment for the prevention of chemotherapy-induced nausea and vomiting in pediatric cancer patients. Chemotherapy-induced nausea and vomiting (CINV) are common and distressing side effects in cancer patients receiving highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC) regimens [1,2]. CINV negatively impacts on patient quality of life [3], and can lead to medical complications and to noncompliance or premature discontinuation of anticancer therapy [4]. It is recognized that children receiving chemotherapy are more prone to vomiting than adults, and it is estimated that 70% of pediatric cancer patients receiving chemotherapy will develop CINV [2].Prevention of CINV in adult cancer patients receiving HEC or MEC regimens can be achieved through the use of antiemetic agents, a combination of a 5-hydroxytryptamine-3 (5-HT 3 ) receptor antagonist, a corticosteroid and a neurokinin-1 (NK 1 ) receptor antagonist is recommended [5][6][7]. While fewer studies of these agents have been performed in pediatric cancer patients than in adults, at the time of the study design, the combination of a 5-HT 3 receptor antagonist with a corticosteroid was recommended for pediatric patients receiving HEC or MEC chemotherapy regimens [2,5,6]. In later guidance from the Pediatric Oncology Group of Ontario (POGO), children scheduled to receive HEC are recommended to receive antiemetic prophylactic therapy of ondansetron or granisetron plus dexamethasone and aprepitant (≥12 years of age and receiving antineoplastic drugs not known to interact with aprepitant) or ondansetron or granisetron plus dexamethasone (<12 years of For reprint orders, please contact: reprints@futuremedicine.com

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