The efficacy of single dose palonosetron in highly emetogenic chemotherapy protocols compared to oral aprepitant and ondansetron

Abstract

Background: Chemotherapy-induced nausea and vomiting (CINV) is a common problem during cancer treatment and its proper management is essential. The primary objective of this study was to compare the efficacy of a single dose palonosetron in the control of chemotherapy-induced nausea and vomiting (CINV) to that of oral aprepitant and ondansetron.  The secondary objective is to determine age, gender, morning sickness, motion sickness, as well as chemotherapy protocols as risk factors in increasing chemotherapy-induced nausea and vomiting (CINV). Methods: This is a prospective cohort study carried out at Al-Andalus Private Hospital for Cancer Patients in Baghdad, Iraq. The study included 296 patients, diagnosed with cancer, and receiving high emetogenic chemotherapy protocol. Patients were divided into 3 arms according to the antiemetic received. Arm 1 received aprepitant and ondansetron, arm 2 received ondansetron, and arm 3 received palonosetron. The primary endpoint was the response rate defined as the percentage of patients without nausea or vomiting episodes during the chemotherapy treatment cycles. Other secondary endpoints such as age, gender, morning sickness, motion sickness, as well as chemotherapy protocols, were measured as risk factors in increasing chemotherapy-induced nausea and vomiting (CINV). Results: A total of 296 patients, diagnosed with cancer, and receiving high emetogenic chemotherapy protocol were evaluated. There was no significant association between age or gender and CINV. The incidence of nausea and vomiting with ondansetron was more than the incidence of nausea and vomiting with aprepitant, and the incidence of nausea and vomiting with palonosetron was less than the incidence of nausea and vomiting with aprepitant. There was no significant association between morning sickness and nausea or vomiting. On the other hand, there was a significant association between motion sickness and nausea or vomiting. The most common cycle reported in nausea and vomiting was cycle 3. Regarding suffering from nausea and vomiting with some chemotherapy drugs, the most common drugs were adriamycin cyclophosphamide (AC) and carboplatin. Conclusion: The results of the present study confirm the previous reports on the superiority of palonosetron over ondansetron and its aprepitant in reducing the incidence of CINV. Regarding risk factors, motion sickness, chemotherapy cycle 3, as well as adriamycin cyclophosphamide (AC) and carboplatin were risk factors inducing CINV in high emetogenic chemotherapy protocols.