Palonosetron in the prevention of chemotherapy-induced nausea and vomiting: An evidence-based review of safety, efficacy, and place in therapy

Luigi Celio, Monica Niger, Francesca Ricchini, Francesco Agustoni

Research output: Contribution to journalArticle

Abstract

Introduction: The second-generation 5-hydroxytryptamine-3 (5-HT3) receptor antagonist palonosetron is effective in the prevention of chemotherapy-induced nausea and vomiting (CINV) associated with highly and moderately emetogenic chemotherapy (HEC and MEC, respectively). In addition, palonosetron has been the first and, at present, the only 5-HT3 receptor antagonist to have a specific indication for the prevention of delayed CINV associated with MEC. The unique pharmacology of this antagonist is thought to partly explain its improved efficacy against delayed symptoms. Aims: To review the evidence underlying the use of palonosetron in preventing CINV. Evidence review: A recent meta-analysis consistently showed that palonosetron significantly increases the control of both emesis and nausea during the acute and delayed phases after single-day HEC or MEC. Consistent with these findings from trials that did not include an neurokinin-1 (NK-1) receptor antagonist, randomized controlled trials recently showed that a triple combination with palonosetron achieves significantly better control of delayed CINV, particularly delayed nausea, in patients undergoing HEC or the high-risk combination of an anthracycline and cyclophosphamide (AC). Evidence from randomized studies also supports palonosetron as a valuable option to reduce the total corticosteroid dose administered in patients undergoing multiple cycles of MEC or AC chemotherapy. Additional benefits of palonosetron include the lack of a warning on cardiac safety and no known clinically significant drug-drug interactions. Place in therapy and conclusion: Evidence currently available indicates that palonosetron significantly adds to the clinician's ability to effectively control CINV in patients undergoing HEC or MEC. It is recommended in the international guidelines for the prevention of CINV caused by MEC. The high safety profile and the opportunity to reduce the total corticosteroid dose with no loss in efficacy against delayed CINV should also contribute to a wider use of palonosetron in clinical practice.

Original languageEnglish
Pages (from-to)75-87
Number of pages13
JournalCore Evidence
Volume10
DOIs
Publication statusPublished - Aug 21 2015

Fingerprint

Nausea
Vomiting
Safety
Drug Therapy
Receptors, Serotonin, 5-HT3
Therapeutics
Anthracyclines
Cyclophosphamide
Adrenal Cortex Hormones
Neurokinin-1 Receptor Antagonists
palonosetron
Drug Interactions
Meta-Analysis
Randomized Controlled Trials
Pharmacology
Guidelines
Pharmaceutical Preparations

Keywords

  • 5-HT<inf>3</inf> receptor antagonist
  • CINV
  • Dexamethasone
  • Highly emetogenic chemotherapy
  • Moderately emetogenic chemotherapy
  • Palonosetron

ASJC Scopus subject areas

  • Medicine(all)
  • Pharmacology
  • Reviews and References, Medical

Cite this

Palonosetron in the prevention of chemotherapy-induced nausea and vomiting : An evidence-based review of safety, efficacy, and place in therapy. / Celio, Luigi; Niger, Monica; Ricchini, Francesca; Agustoni, Francesco.

In: Core Evidence, Vol. 10, 21.08.2015, p. 75-87.

Research output: Contribution to journalArticle

@article{d7a0512dc77f4459acd31e302d51780c,
title = "Palonosetron in the prevention of chemotherapy-induced nausea and vomiting: An evidence-based review of safety, efficacy, and place in therapy",
abstract = "Introduction: The second-generation 5-hydroxytryptamine-3 (5-HT3) receptor antagonist palonosetron is effective in the prevention of chemotherapy-induced nausea and vomiting (CINV) associated with highly and moderately emetogenic chemotherapy (HEC and MEC, respectively). In addition, palonosetron has been the first and, at present, the only 5-HT3 receptor antagonist to have a specific indication for the prevention of delayed CINV associated with MEC. The unique pharmacology of this antagonist is thought to partly explain its improved efficacy against delayed symptoms. Aims: To review the evidence underlying the use of palonosetron in preventing CINV. Evidence review: A recent meta-analysis consistently showed that palonosetron significantly increases the control of both emesis and nausea during the acute and delayed phases after single-day HEC or MEC. Consistent with these findings from trials that did not include an neurokinin-1 (NK-1) receptor antagonist, randomized controlled trials recently showed that a triple combination with palonosetron achieves significantly better control of delayed CINV, particularly delayed nausea, in patients undergoing HEC or the high-risk combination of an anthracycline and cyclophosphamide (AC). Evidence from randomized studies also supports palonosetron as a valuable option to reduce the total corticosteroid dose administered in patients undergoing multiple cycles of MEC or AC chemotherapy. Additional benefits of palonosetron include the lack of a warning on cardiac safety and no known clinically significant drug-drug interactions. Place in therapy and conclusion: Evidence currently available indicates that palonosetron significantly adds to the clinician's ability to effectively control CINV in patients undergoing HEC or MEC. It is recommended in the international guidelines for the prevention of CINV caused by MEC. The high safety profile and the opportunity to reduce the total corticosteroid dose with no loss in efficacy against delayed CINV should also contribute to a wider use of palonosetron in clinical practice.",
keywords = "5-HT<inf>3</inf> receptor antagonist, CINV, Dexamethasone, Highly emetogenic chemotherapy, Moderately emetogenic chemotherapy, Palonosetron",
author = "Luigi Celio and Monica Niger and Francesca Ricchini and Francesco Agustoni",
year = "2015",
month = "8",
day = "21",
doi = "10.2147/CE.S65555",
language = "English",
volume = "10",
pages = "75--87",
journal = "Core Evidence",
issn = "1555-1741",
publisher = "Dove Medical Press Ltd.",

}

TY - JOUR

T1 - Palonosetron in the prevention of chemotherapy-induced nausea and vomiting

T2 - An evidence-based review of safety, efficacy, and place in therapy

AU - Celio, Luigi

AU - Niger, Monica

AU - Ricchini, Francesca

AU - Agustoni, Francesco

PY - 2015/8/21

Y1 - 2015/8/21

N2 - Introduction: The second-generation 5-hydroxytryptamine-3 (5-HT3) receptor antagonist palonosetron is effective in the prevention of chemotherapy-induced nausea and vomiting (CINV) associated with highly and moderately emetogenic chemotherapy (HEC and MEC, respectively). In addition, palonosetron has been the first and, at present, the only 5-HT3 receptor antagonist to have a specific indication for the prevention of delayed CINV associated with MEC. The unique pharmacology of this antagonist is thought to partly explain its improved efficacy against delayed symptoms. Aims: To review the evidence underlying the use of palonosetron in preventing CINV. Evidence review: A recent meta-analysis consistently showed that palonosetron significantly increases the control of both emesis and nausea during the acute and delayed phases after single-day HEC or MEC. Consistent with these findings from trials that did not include an neurokinin-1 (NK-1) receptor antagonist, randomized controlled trials recently showed that a triple combination with palonosetron achieves significantly better control of delayed CINV, particularly delayed nausea, in patients undergoing HEC or the high-risk combination of an anthracycline and cyclophosphamide (AC). Evidence from randomized studies also supports palonosetron as a valuable option to reduce the total corticosteroid dose administered in patients undergoing multiple cycles of MEC or AC chemotherapy. Additional benefits of palonosetron include the lack of a warning on cardiac safety and no known clinically significant drug-drug interactions. Place in therapy and conclusion: Evidence currently available indicates that palonosetron significantly adds to the clinician's ability to effectively control CINV in patients undergoing HEC or MEC. It is recommended in the international guidelines for the prevention of CINV caused by MEC. The high safety profile and the opportunity to reduce the total corticosteroid dose with no loss in efficacy against delayed CINV should also contribute to a wider use of palonosetron in clinical practice.

AB - Introduction: The second-generation 5-hydroxytryptamine-3 (5-HT3) receptor antagonist palonosetron is effective in the prevention of chemotherapy-induced nausea and vomiting (CINV) associated with highly and moderately emetogenic chemotherapy (HEC and MEC, respectively). In addition, palonosetron has been the first and, at present, the only 5-HT3 receptor antagonist to have a specific indication for the prevention of delayed CINV associated with MEC. The unique pharmacology of this antagonist is thought to partly explain its improved efficacy against delayed symptoms. Aims: To review the evidence underlying the use of palonosetron in preventing CINV. Evidence review: A recent meta-analysis consistently showed that palonosetron significantly increases the control of both emesis and nausea during the acute and delayed phases after single-day HEC or MEC. Consistent with these findings from trials that did not include an neurokinin-1 (NK-1) receptor antagonist, randomized controlled trials recently showed that a triple combination with palonosetron achieves significantly better control of delayed CINV, particularly delayed nausea, in patients undergoing HEC or the high-risk combination of an anthracycline and cyclophosphamide (AC). Evidence from randomized studies also supports palonosetron as a valuable option to reduce the total corticosteroid dose administered in patients undergoing multiple cycles of MEC or AC chemotherapy. Additional benefits of palonosetron include the lack of a warning on cardiac safety and no known clinically significant drug-drug interactions. Place in therapy and conclusion: Evidence currently available indicates that palonosetron significantly adds to the clinician's ability to effectively control CINV in patients undergoing HEC or MEC. It is recommended in the international guidelines for the prevention of CINV caused by MEC. The high safety profile and the opportunity to reduce the total corticosteroid dose with no loss in efficacy against delayed CINV should also contribute to a wider use of palonosetron in clinical practice.

KW - 5-HT<inf>3</inf> receptor antagonist

KW - CINV

KW - Dexamethasone

KW - Highly emetogenic chemotherapy

KW - Moderately emetogenic chemotherapy

KW - Palonosetron

UR - http://www.scopus.com/inward/record.url?scp=84940387660&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84940387660&partnerID=8YFLogxK

U2 - 10.2147/CE.S65555

DO - 10.2147/CE.S65555

M3 - Article

AN - SCOPUS:84940387660

VL - 10

SP - 75

EP - 87

JO - Core Evidence

JF - Core Evidence

SN - 1555-1741

ER -