Do we still need to study palonosetron for chemotherapy-induced nausea and vomiting? A cumulative meta-analysis

Ronald Chow; Matti Aapro; Rudolph M Navari; Richard Gralla; Nicholas Chiu; Leonard Chiu; Stephanie Chan; Marko Popovic; Henry Lam; Michael Lock; Carlo DeAngelis

doi:10.1016/j.critrevonc.2019.07.017

Do we still need to study palonosetron for chemotherapy-induced nausea and vomiting? A cumulative meta-analysis

Crit Rev Oncol Hematol. 2019 Oct:142:164-186. doi: 10.1016/j.critrevonc.2019.07.017. Epub 2019 Jul 29.

Authors

Ronald Chow¹, Matti Aapro², Rudolph M Navari³, Richard Gralla⁴, Nicholas Chiu⁵, Leonard Chiu⁵, Stephanie Chan⁵, Marko Popovic⁵, Henry Lam⁵, Michael Lock⁶, Carlo DeAngelis⁷

Affiliations

¹ Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, London, ON, Canada. Electronic address: [email protected].
² Cancer Centre, Clinique de Genolier, Genolier, Switzerland.
³ University of Alabama Birmingham School of Medicine, Birmingham, AL, USA.
⁴ Albert Einstein College of Medicine, Bronx, NY, USA.
⁵ Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
⁶ London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, London, ON, Canada.
⁷ Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.

PMID: 31419719
DOI: 10.1016/j.critrevonc.2019.07.017

Abstract

Introduction: The aim is to conduct an updated systematic review comparing palonosetron to other 5-HT₃RAs for the prophylaxis of CINV, assess for publication biases, and determine whether further RCTs are required, that could potentially lead to a different meta-conclusion.

Methods: Random-effects analysis model was used to generate odds ratio (OR), risk differences (RD) and accompanying 95% confidence intervals (CI). Funnel plots to assess for biases and cumulative meta-analyses to assess effect size over time were generated.

Results: 4145 patients were randomized to palonosetron and 4911 received other 5-HT₃RAs. In the majority of efficacy endpoints, the meta-conclusion has not changed over time - recent clinical trials simply narrow CIs the meta-conclusion. Safety profile boasts a stable conclusion over time. No publication biases exist.

Conclusion: Considering the vast amount of resources needed to conduct RCTs, resources should be dedicated to other prophylactic treatments/settings which have not been as well explored.

Keywords: Antiemetic; Chemotherapy-induced nausea and vomiting; Efficacy; Palonosetron; Safety.

Publication types

Comparative Study
Meta-Analysis

MeSH terms

Antiemetics / therapeutic use*
Antineoplastic Agents / adverse effects*
Antineoplastic Agents / therapeutic use
Humans
Nausea / chemically induced
Nausea / prevention & control*
Neoplasms / drug therapy
Odds Ratio
Palonosetron / therapeutic use*
Serotonin 5-HT3 Receptor Antagonists / therapeutic use
Vomiting / chemically induced
Vomiting / prevention & control*

Substances

Antiemetics
Antineoplastic Agents
Serotonin 5-HT3 Receptor Antagonists
Palonosetron