Comparison of Antiemetic Effectiveness of Palonosetron Versus Ondansetron in Patients on Cancer Chemotherapy: A Prospective Observational Study in South Indians

摘要

Introduction: Chemotherapy Induced Nausea and Vomiting(CINV) is the most distressing side effect of cancer chemotherapy.It can seriously produce an impact on patient's quality of life.Prevention of CINV is far more effective than treatment of anestablished CINV. If the patient receives an optimal antiemeticregimen during the initial course of chemotherapy, thelikelihood of developing emesis is greatly reduced. Although,all first generation 5HT3 antagonists demonstrate reasonableefficacy in preventing acute CINV, delayed CINV still remains aproblem.Aim: To compare the effectiveness and safety of palonosetronversus ondansetron as an antiemetic agent in patients receivingcancer chemotherapy.Materials and Methods: A prospective observational studywas conducted in 106 patients in each treatment arm. Studyduration was 12 months from January 2013 to January 2014.Consecutive patients diagnosed with cancer satisfying inclusioncriteria, who were about to receive moderately or highlyemetogenic chemotherapy were enrolled into the study aftergetting informed written consent. Each patient received eitherIntravenous (IV) palonosetron 0.25 mg or ondansetron 8 mghalf an hour before chemotherapy as antiemetic. Patients werefollowed up for a period of five days following chemotherapy.Number of episodes, severity of vomiting and nausea andantiemetic rescue given if any were recorded. The data weregraded using NCI-CTCAE (VERSION 3.0). Proportion of patientswith nausea and vomiting during acute (0-24 hours), delayed(24-120 hours) and overall period (0-120 hours) in both thestudy groups were compared. Outcome was assessed in termsof symptom control and response. Data were analysed usingSPSS-16.0 statistical software (IBM). Chi-square test was usedto compare the difference in clinical response.Results: Complete response during acute phase in ondansetrongroup was 80.2%, while for palonosetron it was 89.6%. Duringdelayed phase, ondansetron and palonosetron producedcomplete response in 70.8% and 86.8% respectively. A total of65.1% and 82.1% of subjects experienced complete responseduring the overall period in the ondansetron and palonosetrongroups respectively. The difference in the response to antiemeticprophylaxis was statistically significant between the two groupsfor delayed (p-value = 0.006) and overall phase (p-value =0.008).Conclusion: Palonosetron is clinically more efficacious thanondansetron in controlling CINV especially in delayed phaseand overall period of emesis.