Craver, C., Gayle, J., Balu, S., & Buchner, D. (2011). Palonosetron versus other 5-HT3 receptor antagonists for prevention of chemotherapy-induced nausea and vomiting in patients with hematologic malignancies treated with emetogenic chemotherapy in a hospital outpatient setting in the United States. Journal of Medical Economics, 14(3), 341–349.
To evaluate the rate of uncontrolled chemotherapy-induced nausea and vomiting (CINV) after initiation of antiemetic prophylaxis with palonosetron as compared to all other 5-HT3 antagonists in patients diagnosed with hematologic malignancies and receiving highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC)
Subjects who were 18 or older, were identified from eight million cancer discharges that are part of the Premier Perspective Database, which includes data from more than 600 hospital systems. After establishing the correct diagnosis and pharmacologic treatment, data were retrospectively extracted from the database from initiation of chemotherapy to the end of eight rounds of chemotherapy treatment or for six months.
This was a multisite, outpatient study based on the Premier Perspective Database containing data from more than 600 hospitals.
This was a longitudinal, retrospective observational study.
The primary study outcome was rate of uncontrolled CINV events in the study follow-up period of eight cycles of chemotherapy or six months, with events operationally defined by either the need for rescue antiemetics on day two or by any of the ICD-9 codes for nausea, vomiting or volume depletion, dehydration, or hypovolemia. The unit of analysis was one cycle, defined as number of treatments in seven days.
Patients treated with palonosetron in the outpatient setting had significantly lower CINV event rates (decrease of 20%) versus patients treated with other 5-HT3 antagonists after adjusting for baseline differences. However, because this study did not look at the contribution of other antiemetics (e.g., aprepitant, dexamethasone), we may only conclude that in a fairly large sample of patients from the Premier Perspective Database, the group of patients who were given palonosetron on the initiation of HEC or MEC experienced less CINV.
Palonosetron should be considered for the prevention of CINV in patients with hematologic malignancies being treated with HEC or MEC.