Category: Professional Posters
Purpose: Patients on multiple-day chemotherapy often experience acute and delayed nausea and vomiting during the treatment period. However, no effective method for preventing multiple-day chemotherapy-induced nausea and vomiting has been determined. This study aimed to explore the efficacy of the second-generation 5-HT3 antagonist palonosetron for multiple-day chemotherapy-induced nausea and vomiting compared with that of first-generation 5-HT3 receptor antagonists.
Methods: This case-control study enrolled patients administered 5-day cisplatin-based combination chemotherapy (bleomycin 30 U IV weekly plus etoposide 100 mg/m2 IV and cisplatin 20 mg/m2 IV, both on days 1-5; every 21 days) who were given aprepitant, dexamethasone and first-generation 5-HT3 antagonist, granisetron or ramosetron, or the second-generation palonosetron. The patients were then divided into two groups: the first generation group comprised patients given first-generation drugs (granisetron 3 mg or ramosetron 0.3 mg once daily as intravenous dose) before chemotherapy initiation on days 1-5, while the palonosetron group comprised patients given palonosetron 0.75 mg once before chemotherapy initiation on day 1. The proportions of patients with complete response, complete control, or total control during the overall (0-216 h), remedial (0-120 h), and after (120-216 h) phases were evaluated. The remedial phase was further divided into early (0-24 h) and later (24-120 h) phases. Additionally, we evaluated patient’s nutritional status using calories per day according to oral intake.
Results: A total of 43 patients were enrolled. The first-generation drugs and palonosetron were administered in 21 and 22 patients, respectively. The complete response rate of the later phase was significantly higher in the palonosetron group (17/22; 77.3%) than that in the first generation group (10/21; 47.6%) (P=0.04). The number of patients who achieved, complete control and total control were significantly higher in the palonosetron group than that in the first-generation group in the after phase (complete control: P = 0.05, total control: P=0.03). Additionally, caloric oral intake was higher in the palonosetron group than that in the first-generation group. Regarding nutritional status, dietary calorie intake in the treatment period was lower than that before BEP therapy, and the decreased calorie intake lasted in the after treatment period. However, the decrease in the palonosetron group was milder than that in the first-generation group. Particularly, caloric intake in the later phase and after phase were significantly higher in the palonosetron group than that in the first-generation group (later phase: 1351.8 ± 618.6 kcal/day vs. 885.5 ± 722.0 kcal/day, P=0.03; after phase: 1377.3 ± 574.5 kcal/day vs. 885.8 ± 743.2 kcal/day, P=0.02).
Conclusion: Palonosetron significantly reduces vomiting during chemotherapy and maintains dietary intake. Therefore, palonosetron is more effective for controlling multiple-day chemotherapy-induced nausea and vomiting.