Comparison between Antiemetic Effects of Palonosetron and Granisetron on Chemotherapy-Induced Nausea and Vomiting in Japanese Patients Treated with R-CHOP

Abstract

In the present study, the antiemetic effect of palonosetron, not combined with dexamethasone and aprepitant, on chemotherapy-induced nausea and vomiting was evaluated in patients with malignant lymphoma receiving first-line rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy, and was compared to that of granisetron. A total of 74 patients with non-Hodgkin lymphoma were included in this study (April 2007 to December 2015). Palonosetron (0.75 mg) or granisetron (3 mg) was intravenously administered before R-CHOP therapy. The proportions of patients with complete response (CR) during the overall (0-120 h after the start of R-CHOP therapy), acute (0-24 h) and delayed (24-120 h) phases were evaluated. CR was defined as no vomiting and no use of antiemetic rescue medication. A total of 32 and 42 patients were treated with palonosetron and granisetron, respectively. The CR rate in the palonosetron group was significantly higher than that in the granisetron group during the delayed phase (90.6 and 61.9%, respectively; p=0.007). Logistic regression analysis showed that use of palonosetron improved the CR rate during the delayed phase, compared to use of granisetron. Female sex, age less than 60 years, no habitual alcohol intake, and Eastern Cooperative Oncology Group performance status (ECOG-PS) score of 1 were significant risk factors associated with non-CR. The findings of this study suggested the superiority of palonosetron to granisetron, without accompanying dexamethasone and aprepitant, for chemotherapy-induced nausea and vomiting in patients with malignant lymphoma.

Antiemetic efficacy and safety of granisetron or palonosetron alone and in combination with a corticosteroid for ABVD therapy-induced nausea and vomiting

“…Regarding treatment-related SEs, the frequency of anorexia, leucopenia, neutropenia and stomatitis in the palonosetron group was significantly higher than that in the granisetron group in the present study (Table 3 ). This was almost consistent with the result of our previous report in patients with malignant lymphoma receiving first-line rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone [ 9 ]. The interaction of a 5-HT 3 receptor antagonist with its target receptor families can affect the peripheral and central nervous system and the immune responses as well [ 29 – 31 ], possibly associated with the above-mentioned SEs.…”

“…On the contrary, it has been reported that the second-generation palonosetron had the antiemetic effects superior to those of the first-generation 5-HT 3 receptor antagonists ondansetron [ 6 , 7 ] and dolasetron [ 8 ] during the overall, acute, and delayed phases. In our present study, the ability of palonosetron compared to granisetron to appropriately suppressed delayed CINV in patients receiving rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone in combination therapy therapy [ 9 ], although it is unclear which is more effective against CINV associated with ABVD therapy, granisetron- or palonosetron-based antiemetic treatment.…”

Patient-Related Risk Factors for Chemotherapy-Induced Nausea and Vomiting: A Systematic Review

“…Age Age was analyzed in 44 studies among which 27 studies (Pollera and Giannarelli, 1989;Hursti et al, 1996;Booth et al, 2007;Dranitsaris et al, 2009;Petrella et al, 2009;Hesketh et al, 2010;Roscoe et al, 2010;Warr et al, 2011;Bourdeanu et al, 2012;Celio et al, 2012;Hilarius et al, 2012;Molassiotis et al, 2013;Sekine et al, 2013;Molassiotis et al, 2014;Murakami et al, 2014;Tamura et al, 2015;Di Mattei et al, 2016;Iihara et al, 2016;Mizuno et al, 2016;Molassiotis et al, 2016;Rha et al, 2016;Dranitsaris et al, 2017;Uchida et al, 2017;Kawazoe et al, 2018;Nawa-Nishigaki et al, 2018;Shimokawa et al, 2019;Tsuji et al, 2019) confirmed that age is a risk factor of CINV. Out of those 27 studies, 26 studies confirmed that younger patients are at higher risk of CINV than older patients (p < 0.05).…”

“…Out of those 27 studies, 26 studies confirmed that younger patients are at higher risk of CINV than older patients (p < 0.05). However, the age threshold varied from 40 to 67 in 21 studies (Pollera and Giannarelli, 1989;Hursti et al, 1996;Booth et al, 2007;Dranitsaris et al, 2009;Petrella et al, 2009;Hesketh et al, 2010;Roscoe et al, 2010;Warr et al, 2011;Bourdeanu et al, 2012;Celio et al, 2012;Hilarius et al, 2012;Sekine et al, 2013;Jordan et al, 2014;Murakami et al, 2014;Iihara et al, 2016;Rha et al, 2016;Dranitsaris et al, 2017;Uchida et al, 2017;Kawazoe et al, 2018;Nawa-Nishigaki et al, 2018;Tsuji et al, 2019) and six studies (Molassiotis et al, 2013;Tamura et al, 2015;Di Mattei et al, 2016; Mizuno et al, 2016;Molassiotis et al, 2016;Shimokawa et al, 2019) considered age as a continuous variable in which five studies reported required results for computing the summary odds ratio. The thresholds were as follows: age < 40 (n = 4), age ≤ 50 (n = 3), age ≤ 55 (n = 7), age < 60 (n = 4), age < 65 (n = 2), and age < 67 (n = 1) (see Table 2).…”

Comparative Quantification of Chemotherapy-Induced Nausea and Emesis between the Common Terminology Criteria for Adverse Events and the Multinational Association of Supportive Care in Cancer Antiemesis Tool

“…To control CINV, palonosetron is recommended for HEC by the Multinational Association of Supportive Care in Cancer 8) and for MEC by the National Comprehensive Cancer Network 8) and the American Society of Clinical Oncology. 9) According to these antiemetic guidelines, the single administration of palonosetron is relatively effective against both acute and delayed CINV, irrespective of HEC and MEC regimens. [10][11][12] The severity of CINV is generally evaluated by oncology specialists using CTCAE, although this system not entirely consistent with patient evaluations, especially in the delayed phase.…”