Data-driven medical decision-making in managing chemotherapy-induced nausea and vomiting

Impact of initiating antiemetic prophylaxis with palonosetron versus ondansetron on risk of uncontrolled chemotherapy-induced nausea and vomiting in patients with lung cancer receiving multi-day chemotherapy

“…The palonosetron-associated gains over ondansetron in improving CINV control are also consistent with the published findings of an earlier EMR-based retrospective review of the GCS experience with day 1 use of palonosetron versus ondansetron during 2005-2006, describing resource-consuming extreme CINV events (including rescue antiemetic use and office visits for CINV) from single-day emetogenic chemotherapy irrespective of tumor type [4]. In this >3,000-patient analysis, breast cancer was the most common diagnosis (26% of the population), followed by lung cancer (22% of the population).…”

“…It is well recognized that chemotherapy-induced nausea and vomiting (CINV) has broad clinical and economic implications, causing physical/mental distress and impaired day-today functioning and quality of life (QOL) and impacting treatment delivery and outpatient and inpatient resource utilization [1][2][3][4][5][6]. Emetogenicity is the primary consideration for decision making surrounding prophylactic antiemetic therapy; platinum agents are among the most emetogenic agents, with carboplatin designated as moderately emetogenic chemotherapy (MEC) and cisplatin as highly emetogenic chemotherapy (HEC) [7].…”

Pooled analysis of phase III clinical studies of palonosetron versus ondansetron, dolasetron, and granisetron in the prevention of chemotherapy-induced nausea and vomiting (CINV)

“…For example, among patients with breast or lung cancer on HEC or MEC, the risk of CINV events requiring hospital or emergency department visits was significantly reduced with palonosetron as compared to other 5-HT 3 RA-based regimens [ 31 ]. Another study demonstrated that palonosetron was associated with significantly fewer extreme CINV events, resulting in a substantial reduction in both the use of rescue antiemetics and staff management time [ 32 ]. In addition, because patients who experience CINV during one cycle of chemotherapy are more likely to experience CINV in subsequent cycles [ 33 ], the economic benefits of preventing CINV during an initial cycle of chemotherapy would be expected to extend to subsequent cycles.…”

Palonosetron in the management of chemotherapy- induced nausea and vomiting in patients receiving multiple-day chemotherapy

“…This case emphasizes that poor CINV management can reduce a patient’s quality of life 71 while increasing caregiver burden. In addition, poorly controlled CINV can be costly.…”

“…Tina Shih et al72 demonstrated that despite the use of a 5-HT 3 RA, uncontrolled CINV can pose a $1,383 monthly increase in direct medical costs compared with controlled CINV ( P <0.0001). Palonosetron has also been found to reduce extreme CINV events (eg, hospitalizations and emergency room and outpatient visits due to CINV) and costs by up to 76% compared with other 5-HT 3 RAs, and has reduced staff management work time by approximately 4 months 71. Although the GTP was convenient for the patient in this case, there is limited evidence to support the efficacy of the GTP for multiple-day MEC,73 and no published data are available evaluating GTP specifically in patients undergoing treatment for glioma.…”