palonosetron and Carcinoma--Non-Small-Cell-Lung

Although antiemetic management has improved, better control of chemotherapy-induced nausea and vomiting (CINV), particularly during the delayed phase, is needed. The benefit of combination therapy using dexamethasone and the second-generation 5-hydroxytryptamine-3 receptor antagonist palonosetron compared with that of other such receptor antagonists in carboplatin-based chemotherapy is unclear. The effectiveness of adding aprepitant for CINV treatment in moderate emetogenic chemotherapy is also unknown. We compared the efficacy and safety of triple antiemetic therapy using aprepitant, palonosetron, and dexamethasone with that of double antiemetic therapy using palonosetron and dexamethasone in patients with advanced non-small-cell lung cancer receiving carboplatin-containing chemotherapy.. Chemotherapy-naïve patients with non-small-cell lung cancer were enrolled in this prospective controlled study. Eighty patients were randomly assigned to groups receiving either double antiemetic therapy with palonosetron and dexamethasone, or triple antiemetic therapy with aprepitant, palonosetron, and dexamethasone. Complete response rate (no vomiting episode and no rescue therapy) was evaluated as the primary endpoint during the 5-day post-chemotherapy period.. The aprepitant add-on and double therapy groups showed overall complete response rates of 80.5% (95% confidence interval [CI]: 68.4-92.6%) and 76.9% (95% CI: 63.7-90.1%; odds ratio [OR]: 0.81; 95% CI; 0.27-2.36; p=0.788), respectively. Complete responses in the acute and delayed phases and overall incidences of treatment-related adverse events were similar between groups.. According to the selection design, triple antiemetic therapy with aprepitant, palonosetron, and dexamethasone was not considered as an option for further studies.

Topics: Adult; Aged; Aged, 80 and over; Antiemetics; Antineoplastic Combined Chemotherapy Protocols; Carboplatin; Carcinoma, Non-Small-Cell Lung; Dexamethasone; Female; Humans; Isoquinolines; Lung Neoplasms; Male; Middle Aged; Nausea; Neoplasm Staging; Odds Ratio; Palonosetron; Quinuclidines; Treatment Outcome; Vomiting

Lung cancer is the leading cause of cancer-related death for both men and women worldwide, and lung cancer also has the highest morbidity and mortality rate among all cancers in China. Chemotherapy (CT) is the most effective and most widely used treatment for lung cancer. Nausea and vomiting are still among the most unpleasant side effects of chemotherapy, especially during highly emetogenic chemotherapy. The standard therapy for preventing chemotherapy-induced nausea and vomiting (CINV) is 5-hydroxytryptamine 3 (5-HT3) receptor antagonists. Palonosetron is a highly potent second-generation selective 5-HT3 receptor antagonist with stronger binding affinity for the 5-HT3 receptor. Palonosetron showed a high antiemetic activity in preclinical study and pivotal trails enrolling patients treated with moderately or high antiemetic activity drugs. Aim of the study was to verify the activity and safety of palonosetron in patients affected by non-small-cell lung carcinoma (NSCLC) and treated with chemotherapy. Patients with stage II-IV NSCLC and receiving chemotherapy entered into the trial. Informed written consent was required. Patients were randomized to received palonosetron or ondasetron. A single pretreatment dose of palonosetron 0.25 mg intravenous followed was administered. Nausea and vomiting were evaluated over 7-day period. Also the adverse effects were reported. Adverse events were evaluated according to the NCI-CTC criteria. Eighty-nine patients were enrolled into the study. The complete responses during the acute phase were 95.4 and 93.3%, respectively. The main side effects were headache 4.5%, constipation 15.7%, anxiety 2.3%. Palonosetron is a very active antiemetic drug for the prevention of nausea and vomiting in NSCLC patients received chemotherapy.

Topics: Adult; Aged; Antiemetics; Antineoplastic Agents; Carcinoma, Non-Small-Cell Lung; Female; Humans; Isoquinolines; Lung Neoplasms; Male; Middle Aged; Nausea; Neoplasm Staging; Ondansetron; Palonosetron; Quinuclidines; Vomiting