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

Abstract

Prevention of chemotherapy-induced nausea and vomiting (CINV) is a key component of treatment for patients with cancer. Guidelines are available to assist prescribers in the management of CINV associated with single-day chemotherapy regimens. However, currently there are no clear guidelines for management of CINV in patients receiving multiple-day chemotherapy regimens. Serotonin (5-HT3) receptor antagonists are a mainstay in preventing CINV, and palonosetron, given its longer half-life and duration of action relative to other 5-HT3 receptor antagonists, may be a useful option for managing CINV in multiple-day chemotherapy. Here we provide an overview of CINV and CINV treatment options, with a focus on palonosetron. We describe existing challenges in managing CINV, and discuss two patients receiving multiple-day chemotherapy, in whom CINV was managed successfully with palonosetron.

Combination of Palonosetron, Aprepitant, and Dexamethasone Effectively Controls Chemotherapy-induced Nausea and Vomiting in Patients Treated with Concomitant Temozolomide and Radiotherapy: Results of a Prospective Study

“…In the setting of multiple-day chemotherapy, daily, continuous emetogenic stimuli result in an overlap of acute and delayed CINV, particularly during the late phase of the treatment, leading to difficulty in determining the optimal strategy. 6,13) The efficacy of antiemetic therapies as observed in studies of single-day chemotherapy may not be applicable to multiple-day chemotherapy because the patterns and mechanisms of CINV associated with multiple-day chemotherapy may differ from those associated with single-day chemotherapy. On the basis of the high rates of CINV associated with concomitant TMZ and radiotherapy reported by our previous study, the combination of palonosetron, aprepitant, and dexamethasone can be a routine prophylactic antiemetic therapy for concomitant TMZ and radiotherapy which involve a multiple-day, long-term regimen.…”

“…2) Although limited evidence is available for the management of CINV in patients receiving multiple-day chemotherapy regimens, current updated antiemetic guidelines recommend a combination antiemetic regimen that targets multiple molecular pathways that are associated with emesis. 3–6) Palonosetron is a second-generation 5-HT 3 receptor antagonist with a prolonged half-life that is more effective than first-generation 5-HT 3 receptor antagonists for preventing acute and even delayed CINV. 7) Aprepitant is a potent and selective oral non-peptide antagonist of the neurokinin-1 (NK-1) receptor that prevents delayed emesis.…”

Comparative evaluation of triplet antiemetic schedule versus doublet antiemetic schedule in chemotherapy-induced emesis in head and neck cancer patients

“…CINV is one of the most unpleasant side effects of cancer treatments experienced by cancer patients [ 1 , 2 , 3 ]. Chemotherapy-induced emesis can cause anorexia, nutritional deficiency, metabolic imbalances, altered mental status, degeneration of self care, wound dehiscence, and esophageal tear [ 4 ]. Furthermore, its prolonged manifestation may reduce patients’ quality of life (QOL) [ 5 ].…”

“…Furthermore, its prolonged manifestation may reduce patients’ quality of life (QOL) [ 5 ]. It may also lead to noncompliance of anticancer therapy with premature discontinuation [ 4 ]. As chemotherapy in a curative and palliative way is the key mode of treating cancer; preventing, minimising, and treating CINV have become an indispensable aspect of cancer chemotherapy.…”

“…As chemotherapy in a curative and palliative way is the key mode of treating cancer; preventing, minimising, and treating CINV have become an indispensable aspect of cancer chemotherapy. Although significant progress has been made in the treatment of CINV, patients undergoing chemotherapy continue to report that this side effect is persistent and distressing [ 4 , 6 , 7 ].…”