Clinical Update on Palonosetron in the Management of Chemotherapy-Induced Nausea and Vomiting

Abstract

The need to control chemotherapy-induced nausea and vomiting is continuously stimulating research to find better options for the optimal antiemetic care. Palonosetron is different from conventional serotonin receptor antagonists not only by the fact of having a longer half-life but also by higher binding affinity for serotonin receptors. It is the first agent in the class which is approved for preventing both delayed and acute emesis induced by moderately emetogenic chemotherapy. Recent studies using palonosetron-based antiemetic regimens, as well as in the clinical setting of multiple-day chemotherapy, have been reported. Palonosetron plus dexamethasone given as a pre-treatment infusion was effective for preventing acute and delayed emesis after moderately emetogenic chemotherapy. Palonosetron in combination with dexamethasone and aprepitant was highly effective in preventing emesis in the days following administration of moderately emetogenic chemotherapy. Treatment was well tolerated, with no unexpected adverse events. Multiple-day dosing of palonosetron plus dexamethasone was safe and effective for prevention of emesis induced by 5-day cisplatin-based chemotherapy. There was no evidence of cumulative toxicity when palonosetron was given three times over 5 days. Further evidence from ongoing clinical trials with palonosetron with or without dexamethasone will be available soon. Palonosetron represents an useful addition to the therapeutic armamentarium for the management of chemotherapy-induced nausea and vomiting. Further studies are needed to assess the effectiveness of palonosetron in combination with dexamethasone compared with that of older serotonin receptor antagonists combined with dexamethasone. However, palonosetron may offer advantages of convenience over the short-acting older antagonists due to its ability to be given as a single intravenous dose prior to chemotherapy.

Efficacy of palonosetron (PAL) compared to other serotonin inhibitors (5-HT3R) in preventing chemotherapy-induced nausea and vomiting (CINV) in patients receiving moderately or highly emetogenic (MoHE) treatment: systematic review and meta-analysis

“…Thirty two studies were selected and retrieved for fulltext analysis. Of these studies, 27 were excluded for various reasons, described on Table 1 [16,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43].…”

Prevention of acute chemotherapy-induced nausea and vomiting: the role of palonosetron

“…Acute CINV occurs within the first 24 hours after chemotherapy initiation, while delayed emesis occurs between days 2 to 5 (24 to 120 hours postchemotherapy) 4. It should be noted that the strongest predictor of delayed CINV is the occurrence of symptoms in the acute phase, but delayed emesis arises in the absence of acute symptoms in 18% to 24% of patients 5. Patients who are not sufficiently protected from emesis during the first chemotherapy cycle are also at high risk of developing anticipatory nausea and vomiting 6.…”

Palonosetron plus single-dose dexamethasone for the prevention of nausea and vomiting in women receiving anthracycline/cyclophosphamide-containing chemotherapy: meta-analysis of individual patient data examining the effect of age on outcome in two phase III trials

“…The second-generation serotonin (5-HT 3 )-receptor antagonist palonosetron is the only agent in the class that was approved by the Food and Drug Administration for use in preventing delayed nausea and vomiting after single-day administration of moderately emetogenic chemotherapy (MEC) [5]. In a recently reported double-blind, randomized phase III trial in patients undergoing either cisplatin or AC-containing chemotherapy, palonosetron plus dexamethasone for 3 days provided complete protection against delayed CINV that was superior to a single-dose of granisetron plus 3-day dexamethasone [6].…”