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Li P, Zhu M, Gao A, Guo H, Fu A, Zhao A, Guo D. A case-control study on the clinical characteristics of granisetron-related arrhythmias and the development of a predictive nomogram. Int J Clin Pharm 2024; 46:684-693. [PMID: 38416350 DOI: 10.1007/s11096-024-01703-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/14/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Automatic monitoring and assessment are increasingly employed in drug safety evaluations using hospital information system data. The increasing concern about granisetron-related arrhythmias requires real-world studies to improve our understanding of its safety. AIM This study aimed to analyze the incidence, clinical characteristics, and risk factors of granisetron-related arrhythmias in hospitalized patients using real-world data obtained from the Adverse Drug Event Active Surveillance and Assessment System-II (ADE-ASAS-II) and concurrently aimed to develop and validate a nomogram to predict the occurrence of arrhythmias. METHOD Retrospective automatic monitoring of inpatients using granisetron was conducted in a Chinese hospital from January 1, 2017, to December 31, 2021, to determine the incidence of arrhythmias using ADE-ASAS- II. Propensity score matching was used to balance confounders and analyze clinical characteristics. Based on risk factors identified through logistic regression analysis, a prediction nomogram was established and internally validated using the Bootstrap method. RESULTS Arrhythmias occurred in 178 of 72,508 cases taking granisetron with an incidence of 0.3%. Independent risk factors for granisetron-related arrhythmias included medication duration, comorbid cardiovascular disease, concomitant use of other 5-hydroxytryptamine 3 receptor antagonists, alanine aminotransferase > 40 U/L, and blood urea nitrogen > 7.5 mmol/L. The nomogram demonstrated good differentiation and calibration, with enhanced clinical benefit observed when the risk threshold ranged from 0.10 to 0.82. CONCLUSION The nomogram, based on the five identified independent risk factors, may be valuable in predicting the risk of granisetron-related arrhythmias in the administered population, offering significant clinical applications.
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Affiliation(s)
- Peng Li
- Chinese People's Liberation Army Medical School, Beijing, 100853, China
- Department of Pharmacy, Medical Supplies Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Man Zhu
- Department of Pharmacy, Medical Supplies Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Ao Gao
- Department of Pharmacy, Medical Supplies Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Haili Guo
- Chinese People's Liberation Army Medical School, Beijing, 100853, China
- Department of Pharmacy, Medical Supplies Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - An Fu
- Chinese People's Liberation Army Medical School, Beijing, 100853, China
- Department of Pharmacy, Medical Supplies Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Anqi Zhao
- Chinese People's Liberation Army Medical School, Beijing, 100853, China
- Department of Pharmacy, Medical Supplies Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China
| | - Daihong Guo
- Department of Pharmacy, Medical Supplies Center, Chinese People's Liberation Army General Hospital, Beijing, 100853, China.
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Herrstedt J, Lindberg S, Petersen PC. Prevention of Chemotherapy-Induced Nausea and Vomiting in the Older Patient: Optimizing Outcomes. Drugs Aging 2021; 39:1-21. [PMID: 34882284 PMCID: PMC8654643 DOI: 10.1007/s40266-021-00909-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/25/2022]
Abstract
Chemotherapy-induced nausea and vomiting (CINV) are still two of the most feared side effects of cancer therapy. Although major progress in the prophylaxis of CINV has been made during the past 40 years, nausea in particular remains a significant problem. Older patients have a lower risk of CINV than younger patients, but are at a higher risk of severe consequences of dehydration and electrolyte disturbances following emesis. Age-related organ deficiencies, comorbidities, polypharmacy, risk of drug–drug interactions, and lack of compliance all need to be addressed in the older patient with cancer at risk of CINV. Guidelines provide evidence-based recommendations for the prophylaxis of CINV, but none of these guidelines offer specific recommendations for older patients with cancer. This means that the recommendations may lead to overtreatment in some older patients. This review describes the development of antiemetic prophylaxis of CINV focusing on older patients, summarizes recommendations from antiemetic guidelines, describes deficiencies in our knowledge of older patients, summarizes necessary precautions, and suggests some future perspectives for antiemetic research in older patients.
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Affiliation(s)
- Jørn Herrstedt
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde and Næstved, Sygehusvej 10, 4000, Roskilde, Denmark. .,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Sanne Lindberg
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde and Næstved, Sygehusvej 10, 4000, Roskilde, Denmark
| | - Peter Clausager Petersen
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde and Næstved, Sygehusvej 10, 4000, Roskilde, Denmark
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Barnes M, Calcanes G, Mosier MC, Vacirca J, Malik Z. Granisetron Extended-Release Subcutaneous Injection versus Palonosetron Infusion for CINV Prevention: Cost Comparison of Unscheduled Hydration. AMERICAN HEALTH & DRUG BENEFITS 2021; 14:133-139. [PMID: 35261717 PMCID: PMC8844637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/17/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Granisetron extended-release subcutaneous (SC) injection is a novel formulation of granisetron for the prevention of acute and delayed chemotherapy-induced nausea and vomiting (CINV). Palonosetron is administered intravenously and is indicated for CINV prevention in acute and delayed phases after the use of moderately emetogenic chemotherapy (MEC) and in the acute phase after highly emetogenic chemotherapy (HEC). No data are available regarding the impact of SC granisetron on the cost of unscheduled hydration compared with other antiemetic drugs, specifically the older-generation palonosetron. OBJECTIVE To compare the costs of unscheduled hydration associated with breakthrough CINV after SC granisetron versus palonosetron administration in patients receiving MEC or HEC. METHODS This retrospective analysis was based on electronic medical records data from a single multicenter, community-based practice involving patients receiving MEC or HEC with a 3-drug antiemetic regimen, including a neurokinin-1 receptor antagonist, dexamethasone, and either SC granisetron or palonosetron. A cost-of-care analysis for SC granisetron and palonosetron was based on the maximum per-unit Medicare reimbursement amounts for the use of unscheduled hydration, administration of rescue antiemetic drugs, laboratory tests, and patient office evaluations. RESULTS A total of 182 patient records were evaluated, 91 for patients receiving SC granisetron and 91 receiving palonosetron. The mean per-patient cost of care related to unscheduled hydration in patients receiving HEC or MEC was significantly lower with SC granisetron ($296) than palonosetron ($837; P <.0001), including subset analysis of patients requiring additional care (SC granisetron [$691], N = 39; palonosetron [$1058], N = 72; P = .0260). The mean hydration costs per patient receiving HEC or MEC were lower with SC granisetron ($62) than with palonosetron ($253; P <.0001). The hydration costs per patient receiving only HEC were lower with SC granisetron ($66) than palonosetron ($280; P <.0001). The per-patient costs were lower when SC granisetron was administered than when palonosetron was administered as part of the antiemetic regimen, except for the cost of rescue antiemetic drug in patients receiving MEC. Fewer median unscheduled hydration therapies per patient were used with SC granisetron versus palonosetron (HEC, 3 vs 5; MEC, 2 vs 3). CONCLUSION The use of SC granisetron reduced the total per-patient costs of care associated with unscheduled hydration compared with palonosetron in patients receiving HEC or MEC for breakthrough CINV events.
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Affiliation(s)
- Martin Barnes
- Internal Medicine Resident, PGY3, John T. Mather Memorial Hospital, Port Jefferson, NY
| | - George Calcanes
- Chief Clinical Officer, New York Cancer & Blood Specialists, Port Jefferson Station, NY
| | - Michael C Mosier
- Director of Biostatistics, EMB Statistical Solutions, Overland Park, KS
| | - Jeffrey Vacirca
- Chief Executive Officer, New York Cancer & Blood Specialists
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Piechotta V, Adams A, Haque M, Scheckel B, Kreuzberger N, Monsef I, Jordan K, Kuhr K, Skoetz N. Antiemetics for adults for prevention of nausea and vomiting caused by moderately or highly emetogenic chemotherapy: a network meta-analysis. Cochrane Database Syst Rev 2021; 11:CD012775. [PMID: 34784425 PMCID: PMC8594936 DOI: 10.1002/14651858.cd012775.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND About 70% to 80% of adults with cancer experience chemotherapy-induced nausea and vomiting (CINV). CINV remains one of the most distressing symptoms associated with cancer therapy and is associated with decreased adherence to chemotherapy. Combining 5-hydroxytryptamine-3 (5-HT₃) receptor antagonists with corticosteroids or additionally with neurokinin-1 (NK₁) receptor antagonists is effective in preventing CINV among adults receiving highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC). Various treatment options are available, but direct head-to-head comparisons do not allow comparison of all treatments versus another. OBJECTIVES: • In adults with solid cancer or haematological malignancy receiving HEC - To compare the effects of antiemetic treatment combinations including NK₁ receptor antagonists, 5-HT₃ receptor antagonists, and corticosteroids on prevention of acute phase (Day 1), delayed phase (Days 2 to 5), and overall (Days 1 to 5) chemotherapy-induced nausea and vomiting in network meta-analysis (NMA) - To generate a clinically meaningful treatment ranking according to treatment safety and efficacy • In adults with solid cancer or haematological malignancy receiving MEC - To compare whether antiemetic treatment combinations including NK₁ receptor antagonists, 5-HT₃ receptor antagonists, and corticosteroids are superior for prevention of acute phase (Day 1), delayed phase (Days 2 to 5), and overall (Days 1 to 5) chemotherapy-induced nausea and vomiting to treatment combinations including 5-HT₃ receptor antagonists and corticosteroids solely, in network meta-analysis - To generate a clinically meaningful treatment ranking according to treatment safety and efficacy SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, conference proceedings, and study registries from 1988 to February 2021 for randomised controlled trials (RCTs). SELECTION CRITERIA We included RCTs including adults with any cancer receiving HEC or MEC (according to the latest definition) and comparing combination therapies of NK₁ and 5-HT₃ inhibitors and corticosteroids for prevention of CINV. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We expressed treatment effects as risk ratios (RRs). Prioritised outcomes were complete control of vomiting during delayed and overall phases, complete control of nausea during the overall phase, quality of life, serious adverse events (SAEs), and on-study mortality. We assessed GRADE and developed 12 'Summary of findings' tables. We report results of most crucial outcomes in the abstract, that is, complete control of vomiting during the overall phase and SAEs. For a comprehensive illustration of results, we randomly chose aprepitant plus granisetron as exemplary reference treatment for HEC, and granisetron as exemplary reference treatment for MEC. MAIN RESULTS Highly emetogenic chemotherapy (HEC) We included 73 studies reporting on 25,275 participants and comparing 14 treatment combinations with NK₁ and 5-HT₃ inhibitors. All treatment combinations included corticosteroids. Complete control of vomiting during the overall phase We estimated that 704 of 1000 participants achieve complete control of vomiting in the overall treatment phase (one to five days) when treated with aprepitant + granisetron. Evidence from NMA (39 RCTs, 21,642 participants; 12 treatment combinations with NK₁ and 5-HT₃ inhibitors) suggests that the following drug combinations are more efficacious than aprepitant + granisetron for completely controlling vomiting during the overall treatment phase (one to five days): fosnetupitant + palonosetron (810 of 1000; RR 1.15, 95% confidence interval (CI) 0.97 to 1.37; moderate certainty), aprepitant + palonosetron (753 of 1000; RR 1.07, 95% CI 1.98 to 1.18; low-certainty), aprepitant + ramosetron (753 of 1000; RR 1.07, 95% CI 0.95 to 1.21; low certainty), and fosaprepitant + palonosetron (746 of 1000; RR 1.06, 95% CI 0.96 to 1.19; low certainty). Netupitant + palonosetron (704 of 1000; RR 1.00, 95% CI 0.93 to 1.08; high-certainty) and fosaprepitant + granisetron (697 of 1000; RR 0.99, 95% CI 0.93 to 1.06; high-certainty) have little to no impact on complete control of vomiting during the overall treatment phase (one to five days) when compared to aprepitant + granisetron, respectively. Evidence further suggests that the following drug combinations are less efficacious than aprepitant + granisetron in completely controlling vomiting during the overall treatment phase (one to five days) (ordered by decreasing efficacy): aprepitant + ondansetron (676 of 1000; RR 0.96, 95% CI 0.88 to 1.05; low certainty), fosaprepitant + ondansetron (662 of 1000; RR 0.94, 95% CI 0.85 to 1.04; low certainty), casopitant + ondansetron (634 of 1000; RR 0.90, 95% CI 0.79 to 1.03; low certainty), rolapitant + granisetron (627 of 1000; RR 0.89, 95% CI 0.78 to 1.01; moderate certainty), and rolapitant + ondansetron (598 of 1000; RR 0.85, 95% CI 0.65 to 1.12; low certainty). We could not include two treatment combinations (ezlopitant + granisetron, aprepitant + tropisetron) in NMA for this outcome because of missing direct comparisons. Serious adverse events We estimated that 35 of 1000 participants experience any SAEs when treated with aprepitant + granisetron. Evidence from NMA (23 RCTs, 16,065 participants; 11 treatment combinations) suggests that fewer participants may experience SAEs when treated with the following drug combinations than with aprepitant + granisetron: fosaprepitant + ondansetron (8 of 1000; RR 0.23, 95% CI 0.05 to 1.07; low certainty), casopitant + ondansetron (8 of 1000; RR 0.24, 95% CI 0.04 to 1.39; low certainty), netupitant + palonosetron (9 of 1000; RR 0.27, 95% CI 0.05 to 1.58; low certainty), fosaprepitant + granisetron (13 of 1000; RR 0.37, 95% CI 0.09 to 1.50; low certainty), and rolapitant + granisetron (20 of 1000; RR 0.57, 95% CI 0.19 to 1.70; low certainty). Evidence is very uncertain about the effects of aprepitant + ondansetron (8 of 1000; RR 0.22, 95% CI 0.04 to 1.14; very low certainty), aprepitant + ramosetron (11 of 1000; RR 0.31, 95% CI 0.05 to 1.90; very low certainty), fosaprepitant + palonosetron (12 of 1000; RR 0.35, 95% CI 0.04 to 2.95; very low certainty), fosnetupitant + palonosetron (13 of 1000; RR 0.36, 95% CI 0.06 to 2.16; very low certainty), and aprepitant + palonosetron (17 of 1000; RR 0.48, 95% CI 0.05 to 4.78; very low certainty) on the risk of SAEs when compared to aprepitant + granisetron, respectively. We could not include three treatment combinations (ezlopitant + granisetron, aprepitant + tropisetron, rolapitant + ondansetron) in NMA for this outcome because of missing direct comparisons. Moderately emetogenic chemotherapy (MEC) We included 38 studies reporting on 12,038 participants and comparing 15 treatment combinations with NK₁ and 5-HT₃ inhibitors, or 5-HT₃ inhibitors solely. All treatment combinations included corticosteroids. Complete control of vomiting during the overall phase We estimated that 555 of 1000 participants achieve complete control of vomiting in the overall treatment phase (one to five days) when treated with granisetron. Evidence from NMA (22 RCTs, 7800 participants; 11 treatment combinations) suggests that the following drug combinations are more efficacious than granisetron in completely controlling vomiting during the overall treatment phase (one to five days): aprepitant + palonosetron (716 of 1000; RR 1.29, 95% CI 1.00 to 1.66; low certainty), netupitant + palonosetron (694 of 1000; RR 1.25, 95% CI 0.92 to 1.70; low certainty), and rolapitant + granisetron (660 of 1000; RR 1.19, 95% CI 1.06 to 1.33; high certainty). Palonosetron (588 of 1000; RR 1.06, 95% CI 0.85 to 1.32; low certainty) and aprepitant + granisetron (577 of 1000; RR 1.06, 95% CI 0.85 to 1.32; low certainty) may or may not increase complete response in the overall treatment phase (one to five days) when compared to granisetron, respectively. Azasetron (560 of 1000; RR 1.01, 95% CI 0.76 to 1.34; low certainty) may result in little to no difference in complete response in the overall treatment phase (one to five days) when compared to granisetron. Evidence further suggests that the following drug combinations are less efficacious than granisetron in completely controlling vomiting during the overall treatment phase (one to five days) (ordered by decreasing efficacy): fosaprepitant + ondansetron (500 of 100; RR 0.90, 95% CI 0.66 to 1.22; low certainty), aprepitant + ondansetron (477 of 1000; RR 0.86, 95% CI 0.64 to 1.17; low certainty), casopitant + ondansetron (461 of 1000; RR 0.83, 95% CI 0.62 to 1.12; low certainty), and ondansetron (433 of 1000; RR 0.78, 95% CI 0.59 to 1.04; low certainty). We could not include five treatment combinations (fosaprepitant + granisetron, azasetron, dolasetron, ramosetron, tropisetron) in NMA for this outcome because of missing direct comparisons. Serious adverse events We estimated that 153 of 1000 participants experience any SAEs when treated with granisetron. Evidence from pair-wise comparison (1 RCT, 1344 participants) suggests that more participants may experience SAEs when treated with rolapitant + granisetron (176 of 1000; RR 1.15, 95% CI 0.88 to 1.50; low certainty). NMA was not feasible for this outcome because of missing direct comparisons. Certainty of evidence Our main reason for downgrading was serious or very serious imprecision (e.g. due to wide 95% CIs crossing or including unity, few events leading to wide 95% CIs, or small information size). Additional reasons for downgrading some comparisons or whole networks were serious study limitations due to high risk of bias or moderate inconsistency within networks. AUTHORS' CONCLUSIONS This field of supportive cancer care is very well researched. However, new drugs or drug combinations are continuously emerging and need to be systematically researched and assessed. For people receiving HEC, synthesised evidence does not suggest one superior treatment for prevention and control of chemotherapy-induced nausea and vomiting. For people receiving MEC, synthesised evidence does not suggest superiority for treatments including both NK₁ and 5-HT₃ inhibitors when compared to treatments including 5-HT₃ inhibitors only. Rather, the results of our NMA suggest that the choice of 5-HT₃ inhibitor may have an impact on treatment efficacy in preventing CINV. When interpreting the results of this systematic review, it is important for the reader to understand that NMAs are no substitute for direct head-to-head comparisons, and that results of our NMA do not necessarily rule out differences that could be clinically relevant for some individuals.
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Affiliation(s)
- Vanessa Piechotta
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anne Adams
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Madhuri Haque
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Benjamin Scheckel
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Nina Kreuzberger
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Karin Jordan
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Kathrin Kuhr
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nicole Skoetz
- Cochrane Cancer, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Barnes M, Calcanes G, Mosier MC, Vacirca J, Malik Z. Granisetron Extended-Release Subcutaneous Injection versus Palonosetron Infusion for CINV Prevention: Cost Comparison of Unscheduled Hydration. AMERICAN HEALTH & DRUG BENEFITS 2021; 14:1-7. [PMID: 35261710 PMCID: PMC8845525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/17/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Granisetron extended-release subcutaneous (SC) injection is a novel formulation of granisetron for the prevention of acute and delayed chemotherapy-induced nausea and vomiting (CINV). Palonosetron is administered intravenously and is indicated for CINV prevention in acute and delayed phases after the use of moderately emetogenic chemotherapy (MEC) and in the acute phase after highly emetogenic chemotherapy (HEC). No data are available regarding the impact of SC granisetron on the cost of unscheduled hydration compared with other antiemetic drugs, specifically the older-generation palonosetron. OBJECTIVE To compare the costs of unscheduled hydration associated with breakthrough CINV after SC granisetron versus palonosetron administration in patients receiving MEC or HEC. METHODS This retrospective analysis was based on electronic medical records data from a single multicenter, community-based practice involving patients receiving MEC or HEC with a 3-drug antiemetic regimen, including a neurokinin-1 receptor antagonist, dexamethasone, and either SC granisetron or palonosetron. A cost-of-care analysis for SC granisetron and palonosetron was based on the maximum per-unit Medicare reimbursement amounts for the use of unscheduled hydration, administration of rescue antiemetic drugs, laboratory tests, and patient office evaluations. RESULTS A total of 182 patient records were evaluated, 91 for patients receiving SC granisetron and 91 receiving palonosetron. The mean per-patient cost of care related to unscheduled hydration in patients receiving HEC or MEC was significantly lower with SC granisetron ($296) than palonosetron ($837; P <.0001), including subset analysis of patients requiring additional care (SC granisetron [$691], N = 39; palonosetron [$1058], N = 72; P = .0260). The mean hydration costs per patient receiving HEC or MEC were lower with SC granisetron ($62) than with palonosetron ($253; P <.0001). The hydration costs per patient receiving only HEC were lower with SC granisetron ($66) than palonosetron ($280; P <.0001). The per-patient costs were lower when SC granisetron was administered than when palonosetron was administered as part of the antiemetic regimen, except for the cost of rescue antiemetic drug in patients receiving MEC. Fewer median unscheduled hydration therapies per patient were used with SC granisetron versus palonosetron (HEC, 3 vs 5; MEC, 2 vs 3). CONCLUSION The use of SC granisetron reduced the total per-patient costs of care associated with unscheduled hydration compared with palonosetron in patients receiving HEC or MEC for breakthrough CINV events.
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Affiliation(s)
- Martin Barnes
- Internal Medicine Resident, PGY3, John T. Mather Memorial Hospital, Port Jefferson, NY
| | - George Calcanes
- Chief Clinical Officer, New York Cancer & Blood Specialists, Port Jefferson Station, NY
| | - Michael C Mosier
- Director of Biostatistics, EMB Statistical Solutions, Overland Park, KS
| | - Jeffrey Vacirca
- Chief Executive Officer, New York Cancer & Blood Specialists
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Hsu YC, Chen CY, Tam KW, Hsu CY. Effectiveness of palonosetron versus granisetron in preventing chemotherapy-induced nausea and vomiting: a systematic review and meta-analysis. Eur J Clin Pharmacol 2021; 77:1597-1609. [PMID: 33993343 DOI: 10.1007/s00228-021-03157-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Chemotherapy-induced nausea and vomiting (CINV) commonly occurs after chemotherapy, adversely affecting patients' quality of life. Recently, studies have shown inconsistent antiemetic effects of two common 5-hydroxytryptamine 3 receptor antagonists, namely, palonosetron and granisetron. Therefore, we conducted a meta-analysis to evaluate the effectiveness of palonosetron versus granisetron in preventing CINV. METHODS Relevant studies were obtained from PubMed, Embase, and Cochrane databases. The primary outcome was the complete response (CR) rate. Secondary outcomes were headache and constipation events. RESULTS In total, 12 randomized controlled trials and five retrospective studies were reviewed. Palonosetron was consistently statistically superior to granisetron in all phases in terms of the CR rate (acute phases: odds ratio [OR] = 1.28, 95% confidence interval [CI] = 1.06-1.54; delayed phases: OR = 1.38, 95% CI = 1.13-1.69; and overall phases: OR = 1.37, 95% CI = 1.17-1.60). Moreover, a non-significant difference was found between the two groups in terms of the headache event, but the occurrence of the constipation event was lower in the granisetron group than in the palonosetron group. CONCLUSION Palonosetron showed a higher protective efficacy in all phases of CINV prevention, especially in delayed phases, and no relatively severe adverse effects were observed.
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Affiliation(s)
- Yu-Chen Hsu
- Division of Colon and Rectal Surgery, Department of Surgery, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Ching-Yao Chen
- Department of Pharmacy, En Chu Kong Hospital, 399 Fuxing Road Sanxis District, New Taipei City, 23741, Taiwan
| | - Ka-Wai Tam
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - Chin-Yu Hsu
- Department of Pharmacy, En Chu Kong Hospital, 399 Fuxing Road Sanxis District, New Taipei City, 23741, Taiwan.
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Eakin CM, Norton TJ, Monk BJ, Chase DM. Management of nausea and vomiting from poly(ADP-ribose) polymerase inhibitor therapy for advanced ovarian cancer. Gynecol Oncol 2020; 159:581-587. [PMID: 32972786 DOI: 10.1016/j.ygyno.2020.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/12/2020] [Indexed: 01/09/2023]
Abstract
Poly(ADP-ribose) polymerase (PARP) inhibitors have rapidly emerged as a new class of daily oral chemotherapeutic agents that have the potential to dramatically alter the way in which primary peritoneal, fallopian tube and ovarian cancers are treated. However, the management of nausea and vomiting, the most common toxicities incurred by these agents, remains poorly understood. The purpose of this review is to provide an overview of current guidelines, antiemetic agents and management steps for patients experiencing nausea and vomiting associated with the use of PARP inhibitors.
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Affiliation(s)
- Cortney M Eakin
- Creighton University School of Medicine, Phoenix, AZ, United States of America
| | - Taylor J Norton
- University of Arizona College of Medicine, Phoenix, AZ, United States of America
| | - Bradley J Monk
- Creighton University School of Medicine, Phoenix, AZ, United States of America; University of Arizona College of Medicine, Phoenix, AZ, United States of America; Arizona Oncology (US Oncology Network), Phoenix, AZ, United States of America
| | - Dana M Chase
- Creighton University School of Medicine, Phoenix, AZ, United States of America; University of Arizona College of Medicine, Phoenix, AZ, United States of America; Arizona Oncology (US Oncology Network), Phoenix, AZ, United States of America.
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Yang Z, Liu L, Su L, Wu X, Wang Y, Liu L, Lin X. Design of a zero-order sustained release PLGA microspheres for palonosetron hydrochloride with high encapsulation efficiency. Int J Pharm 2020; 575:119006. [DOI: 10.1016/j.ijpharm.2019.119006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/12/2019] [Accepted: 12/28/2019] [Indexed: 02/05/2023]
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Chow R, Aapro M, Navari RM, Gralla R, Chiu N, Chiu L, Chan S, Popovic M, Lam H, Lock M, DeAngelis C. Do we still need to study palonosetron for chemotherapy-induced nausea and vomiting? A cumulative meta-analysis. Crit Rev Oncol Hematol 2019; 142:164-186. [PMID: 31419719 DOI: 10.1016/j.critrevonc.2019.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 07/14/2019] [Accepted: 07/18/2019] [Indexed: 02/08/2023] Open
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.
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Affiliation(s)
- Ronald Chow
- 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.
| | - Matti Aapro
- Cancer Centre, Clinique de Genolier, Genolier, Switzerland
| | - Rudolph M Navari
- University of Alabama Birmingham School of Medicine, Birmingham, AL, USA
| | | | - Nicholas Chiu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Leonard Chiu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Stephanie Chan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Marko Popovic
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Henry Lam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Michael Lock
- London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Carlo DeAngelis
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
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11
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Park SH, Binder G, Corman S, Botteman M. Budget impact of netupitant/palonosetron for the prevention of chemotherapy-induced nausea and vomiting. J Med Econ 2019; 22:840-847. [PMID: 31094589 DOI: 10.1080/13696998.2019.1620244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Chemotherapy-induced nausea and vomiting (CINV) are among the most common and debilitating side-effects patients experience during chemotherapy, and are associated with considerable acute care use and healthcare cost. It is estimated that 70-80% of CINV could be prevented through appropriate use of CINV prophylaxis; however, suboptimal CINV compliance and control remains an issue in clinical practice. Netupitant/palonosetron (NEPA) is a fixed combination of serotonin-3 (5-HT3) and neurokinin-1 (NK1) receptor antagonists (RAs), respectively, indicated for the prevention of acute and delayed nausea and vomiting associated with highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC). Phase 3 clinical trials showed a significantly higher complete response rate in both acute and delayed CINV in chemotherapy-naïve patients receiving NEPA compared to patients receiving palonosetron. Objective: The objective of this study was to estimate the budgetary impact of adding NEPA to a US payer or practice formulary for CINV prophylaxis. Methods: A model was developed to estimate the impact of adding NEPA to the formulary of a hypothetical US payer with 1.15 million members, including 150,000 (13%) Medicare beneficiaries. The model compared the annual total costs of CINV-related events and CINV prophylaxis in two scenarios: base year (no NEPA) and comparator year (10% and 5% NEPA usage in HEC and MEC patients, respectively). A univariate sensitivity analysis was conducted to explore the effect of variability in model parameters on the budget impact. Results: A total of 2,021 patients were eligible to receive CINV prophylaxis. With NEPA, CINV prophylaxis costs increased by 0.7% ($3,493,630 vs $3,518,760) while medical costs associated with CINV events decreased by 3.9% ($15,118,639 vs $14,532,442), resulting in a net cost saving of $561,067 (3.0%) for the health plan ($18,612,269 vs $18,051,202), or $0.04 per member per month. This was equivalent to saving $5,011 per patient moved to NEPA. Among all 5-HT3 RA + NK1 RA regimens, NEPA was associated with the lowest CINV-related costs, leading to the lowest total cost of care. Conclusions: Adding NEPA to a payer or practice formulary results in a net decrease in the total budget due to a substantial reduction in CINV event-related resource utilization and medical costs, and an increase in pharmacy costs <1%, saving over $5,000 per patient.
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Affiliation(s)
- Sang Hee Park
- a Modeling and Meta-analysis , Pharmerit International , Bethesda , MD , USA
| | - Gary Binder
- b HEOR & Value-Based Medicine , Helsinn Therapeutics (US), Inc , Iselin , NJ , USA
| | - Shelby Corman
- a Modeling and Meta-analysis , Pharmerit International , Bethesda , MD , USA
| | - Marc Botteman
- a Modeling and Meta-analysis , Pharmerit International , Bethesda , MD , USA
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12
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Schwartzberg LS, Marks SM, Gabrail NY, Geller RB, Kish J. Real-world effectiveness of palonosetron-based antiemetic regimens: preventing chemotherapy-induced nausea and vomiting. J Comp Eff Res 2019; 8:657-670. [PMID: 31070042 DOI: 10.2217/cer-2018-0104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate real-world effectiveness of guideline-recommended palonosetron-containing antiemetic regimens in patients receiving highly (HEC) or moderately emetogenic (MEC) chemotherapy. Patients & methods: This retrospective analysis used records of adults receiving first-line chemotherapy and a three-drug palonosetron-containing antiemetic regimen for HEC or palonosetron-containing antiemetic regimen for MEC (carboplatin). Results: A total of 1587 records were evaluated. For HEC and MEC, respectively, chemotherapy-induced nausea and vomiting (CINV) occurred in 40 versus 44% of patient cycles (p = 0.01), and unscheduled iv. antiemetics in 41 versus 35% (p < 0.05). A total of 48% of HEC patients versus 42% of MEC patients had CINV-related clinic visits (p = 0.05). Conclusion: Palonosetron-containing antiemetic regimens may provide insufficient CINV control. Alternative regimens may improve patient quality of life and reduce healthcare resource utilization.
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Affiliation(s)
- Lee S Schwartzberg
- Division of Hematology/Oncology, Department of Medicine, University of Tennessee Health Sciences Center and West Cancer Center, 7945 Wolf River Blvd, Germantown, TN 38138, USA
| | - Stanley M Marks
- Division of Medical Hematology/Oncology, UPMC Hillman Cancer Center, 5150 Centre Ave, 5th Floor, Cancer Pavilion, Pittsburgh, PA 15232, USA
| | - Nashat Y Gabrail
- Department of Oncology, Gabrail Cancer Center, 4875 Higbee Ave NW, Canton, OH 44718, USA
| | - Robert B Geller
- Medical Affairs, Heron Therapeutics, Inc., 4242 Campus Point Court, Suite 200, San Diego, CA 92121, USA
| | - Jonathan Kish
- Real World Evidence and Insights, Cardinal Health Specialty Solutions, 7000 Cardinal Place, 4th Floor, Columbus, OH 43017, USA
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13
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Erickson R, Nebughr N, Mosier MC, Nibley W. Hydration requirements in patients receiving highly emetogenic chemotherapy. Future Oncol 2018; 15:753-761. [PMID: 30499739 DOI: 10.2217/fon-2018-0787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
AIM Chemotherapy-induced nausea and vomiting diminishes quality of life and increases healthcare resource use. This retrospective medical records analysis evaluated hydration requirements with emetogenic chemotherapy. PATIENTS & METHODS Cancer patients received moderately emetogenic chemotherapy (MEC) or highly emetogenic chemotherapy (HEC), and antiemetics palonosetron or granisetron extended-release subcutaneous (GERSC), neurokinin 1 receptor antagonist and dexamethasone. Unscheduled hydration event rates were determined. RESULTS For 186 patients (92 palonosetron, 94 GERSC) overall, mean hydration rate was significantly higher with palonosetron (0.6 vs 0.2; p = 0.0005). Proportion of patients with ≥1 hydration event was significantly higher with palonosetron overall (54 vs 33%; p = 0.0033) and in cycles 2-4 and the HEC subgroup. CONCLUSION GERSC within a three-drug antiemetic regimen may reduce unscheduled hydration requirements with MEC or HEC.
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Affiliation(s)
- Randy Erickson
- Utah Cancer Specialists, 1121 East 3900 C-230, Salt Lake City, UT 84124, USA
| | - Neil Nebughr
- Utah Cancer Specialists, 1121 East 3900 C-230, Salt Lake City, UT 84124, USA
| | - Michael C Mosier
- EMB Statistical Solutions, LLC, 55 Corporate Woods, 9300 West 100th Street, Suite 550, Overland Park, KS 66210, USA
| | - William Nibley
- Utah Cancer Specialists, 5131 South Cottonwood Street, Suite 200, Murray, UT 84107, USA
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14
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Gilmore J, D'Amato S, Griffith N, Schwartzberg L. Recent advances in antiemetics: new formulations of 5HT 3-receptor antagonists. Cancer Manag Res 2018; 10:1827-1857. [PMID: 30013391 PMCID: PMC6037149 DOI: 10.2147/cmar.s166912] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose To discuss new therapeutic strategies for chemotherapy-induced nausea and vomiting (CINV) involving 5-hydroxytryptamine type 3 (5HT3)-receptor antagonists (RAs). Summary CINV remains poorly controlled in patients receiving moderately emetogenic chemotherapy (MEC) or highly emetogenic chemotherapy (HEC); nausea and delayed-phase CINV (24-120 hours after chemotherapy) are the most difficult to control. National Comprehensive Cancer Network (NCCN) and American Society of Clinical Oncology (ASCO) antiemesis-guideline recommendations for HEC include a four-drug regimen (5HT3 RA, neurokinin 1 [NK1] RA, dexamethasone, and olanzapine). For some MEC regimens, a three-drug regimen (5HT3 RA, NK1 RA, and dexamethasone) is recommended. While 5HT3 RAs have dramatically improved CINV in the acute phase (0-24 hours after chemotherapy), their efficacy declines in the delayed phase. Newer formulations have been developed to extend 5HT3-RA efficacy into the delayed phase. Granisetron extended-release subcutaneous (GERSC), the most recently approved 5HT3 RA, provides slow, controlled release of therapeutic granisetron concentrations for ≥5 days. GERSC is included in the NCCN and ASCO guidelines for MEC and HEC, with NCCN-preferred status for MEC in the absence of an NK1 RA. Efficacy and safety of 5HT3 RAs in the context of guideline-recommended antiemetic therapy are reviewed. Conclusion Recent updates in antiemetic guidelines and the development of newer antiemet-ics should help mitigate CINV, this dreaded side effect of chemotherapy. GERSC, the most recently approved 5HT3-RA formulation, is indicated for use with other antiemetics to prevent acute and delayed nausea and vomiting associated with initial and repeat courses of MEC and anthracycline-cyclophosphamide combination-chemotherapy regimens.
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Affiliation(s)
- James Gilmore
- Clinical Services, Georgia Cancer Specialists, Atlanta, GA, USA,
| | - Steven D'Amato
- Department of Clinical Pharmacy Services, New England Cancer Specialists, Scarborough, ME, USA
| | | | - Lee Schwartzberg
- West Cancer Center.,Division of Hematology/Oncology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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15
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Vacirca J, Caruana D, Calcanes G, Mosier M, Boccia R, McBride A. Hydration requirements with emetogenic chemotherapy: granisetron extended-release subcutaneous versus palonosetron. Future Oncol 2018; 14:1387-1396. [DOI: 10.2217/fon-2017-0720] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: This retrospective analysis evaluated chemotherapy-induced nausea and vomiting (CINV)-related hydration needs with palonosetron or granisetron extended-release subcutaneous (GERSC), approved in 2016 for CINV prevention. Materials & methods: At a community practice, CINV-related hydration per chemotherapy cycle was determined following highly (HEC) or moderately emetogenic chemotherapy (MEC) and a guideline-recommended antiemetic regimen: NK-1 receptor antagonist, dexamethasone and either palonosetron only, GERSC only, or palonosetron switched to GERSC. Results: Palonosetron-only patients (n = 93) had a significantly higher mean (standard deviation) hydration rate (0.9 [1.1]) than GERSC-only patients (n = 91; 0.3 [0.6]; p < 0.0001). Switched patients’ (n = 48) hydration rates were significantly higher in the HEC subgroup with palonosetron (0.7 [1.2]) versus GERSC (0.5 [1.0]; p = 0.028). Conclusion: GERSC in a three-drug antiemetic regimen may reduce hydration needs following HEC or MEC. [Formula: see text]
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Affiliation(s)
- Jeffrey Vacirca
- New York Cancer & Blood Specialists, 235 N Belle Mead Rd, East Setauket, NY 11733, USA
| | - Dennis Caruana
- New York Cancer & Blood Specialists, 235 N Belle Mead Rd, East Setauket, NY 11733, USA
| | - George Calcanes
- New York Cancer & Blood Specialists, 235 N Belle Mead Rd, East Setauket, NY 11733, USA
| | - Michael Mosier
- EMB Statistical Solutions, LLC, 55 Corporate Woods, 9300 West 110th Street, Suite 550, Overland Park, KS 66210, USA
| | - Ralph Boccia
- Center for Cancer & Blood Disorders, 6410 Rockledge Dr, Suite 660, Bethesda, MD 20817, USA
| | - Ali McBride
- University of Arizona Cancer Center, 3838 N Campbell Ave, Tucson, AZ 85719, USA
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16
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Chow R, Warr DG, Navari RM, Tsao M, Popovic M, Chiu L, Milakovic M, Lam H, DeAngelis C. Should palonosetron be a preferred 5-HT 3 receptor antagonist for chemotherapy-induced nausea and vomiting? An updated systematic review and meta-analysis. Support Care Cancer 2018; 26:2519-2549. [PMID: 29796708 DOI: 10.1007/s00520-018-4237-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 04/26/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE Chemotherapy-induced nausea and vomiting (CINV) continues to be a common side effect of systemic anticancer therapy, decreasing quality of life and increasing resource utilization. The aim of this meta-analysis was to investigate the comparative efficacy and safety of palonosetron relative to other 5-HT3RAs. METHODS A literature search was carried out in Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Full-text references were then screened and included in this meta-analysis if they were an RCT and had adequate data regarding one of the five primary endpoints-complete response (CR), complete control (CC), no emesis, no nausea, or no rescue medications. RESULTS A total of 24 RCTs were included in this review. Palonosetron was statistically superior to other 5-HT3RAs for 10 of the 19 assessed endpoints. Only one endpoint-emesis in the overall phase-had noticeable more favorable data for palonosetron to the point that it approached the 10% risk difference (RD) threshold as specified by the MASCC/ESMO antiemetic panel; another two endpoints (CR in the overall phase and nausea in the delayed phase) approached the 10% threshold. CONCLUSIONS Palonosetron seems to be more efficacious and safe than other 5-HT3RAs-statistically superior in 10 of 19 endpoints. It is, however, only clinically significant in one endpoint and approached clinically significant difference in another two endpoints. Within the limits of this meta-analysis, our results indicate that palonosetron may not be as superior in efficacy and safety as reported in a previous meta-analysis, and supports the recent MASCC/ESMO, ASCO, and NCCN guidelines in not generally indicating palonosetron as the 5-HT3RA of choice.
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Affiliation(s)
- Ronald Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
| | - David G Warr
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Rudolph M Navari
- University of Alabama Birmingham School of Medicine, Birmingham, AL, USA
| | - May Tsao
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Marko Popovic
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Leonard Chiu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Milica Milakovic
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Henry Lam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Carlo DeAngelis
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
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17
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Abstract
The chemotherapy-induced nausea and vomiting (CINV) is one of the most frequent side effects in cytostatic therapy and a profound challenge during the therapy of cancer patients. Therefore, standardized guideline-orientated prophylaxis is essential and a fundamental contribution for the success of treatment. This review summarizes the current recommendations for CINV of the Multinational Association of Supportive Care in Cancer (MASCC) and European Society of Medical Oncology (ESMO), the American Society for Clinical Oncology (ASCO), the National Comprehensive Cancer Network (NCCN) and the S3-guideline Supportive Therapie of the Leitlinienprogramm Onkologie and shall facilitate its use in the daily routine.
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18
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Schwartzberg L. Getting it right the first time: recent progress in optimizing antiemetic usage. Support Care Cancer 2018; 26:19-27. [PMID: 29556812 PMCID: PMC5876255 DOI: 10.1007/s00520-018-4116-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/15/2018] [Indexed: 11/26/2022]
Abstract
Recent years have witnessed significant improvements in the prevention and management of chemotherapy-induced nausea and vomiting (CINV), allowing patients to complete their prescribed chemotherapy regimens without compromising quality of life. This reduction in the incidence of CINV can be primarily attributed to the emergence of effective, well-tolerated antiemetic therapies, including serotonin (5-hydroxytryptamine or 5-HT3) receptor antagonists, neurokinin-1 (NK-1) receptor antagonists, and the atypical antipsychotic olanzapine. While 5-HT3 receptor antagonists are highly effective in the prevention of acute CINV, NK-1 receptor antagonists and olanzapine have demonstrated considerable activity against both acute and delayed CINV. Various combinations of these three types of agents, along with dexamethasone and dopamine receptor antagonists, are now becoming the standard of care for patients receiving moderately or highly emetogenic chemotherapy. Optimal use of these therapies requires careful assessment of the unique characteristics of each agent and currently available clinical trial data.
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19
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Spartinou A, Nyktari V, Papaioannou A. Granisetron: a review of pharmacokinetics and clinical experience in chemotherapy induced - nausea and vomiting. Expert Opin Drug Metab Toxicol 2017; 13:1289-1297. [DOI: 10.1080/17425255.2017.1396317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Anastasia Spartinou
- Department of Anesthesiology, University Hospital of Heraklion, Crete, Greece
| | - Vasileia Nyktari
- Department of Anesthesiology, University Hospital of Heraklion, Crete, Greece
| | - Alexandra Papaioannou
- Department of Anesthesiology, University Hospital of Heraklion, Crete, Greece
- Faculty of Medicine, University of Crete Greece
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20
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Hesketh PJ, Kris MG, Basch E, Bohlke K, Barbour SY, Clark-Snow RA, Danso MA, Dennis K, Dupuis LL, Dusetzina SB, Eng C, Feyer PC, Jordan K, Noonan K, Sparacio D, Somerfield MR, Lyman GH. Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2017; 35:3240-3261. [DOI: 10.1200/jco.2017.74.4789] [Citation(s) in RCA: 369] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose To update the ASCO guideline for antiemetics in oncology. Methods ASCO convened an Expert Panel and conducted a systematic review of the medical literature for the period of November 2009 to June 2016. Results Forty-one publications were included in this systematic review. A phase III randomized controlled trial demonstrated that adding olanzapine to antiemetic prophylaxis reduces the likelihood of nausea among adult patients who are treated with high emetic risk antineoplastic agents. Randomized controlled trials also support an expanded role for neurokinin 1 receptor antagonists in patients who are treated with chemotherapy. Recommendation Key updates include the addition of olanzapine to antiemetic regimens for adults who receive high-emetic-risk antineoplastic agents or who experience breakthrough nausea and vomiting; a recommendation to administer dexamethasone on day 1 only for adults who receive anthracycline and cyclophosphamide chemotherapy; and the addition of a neurokinin 1 receptor antagonist for adults who receive carboplatin area under the curve ≥ 4 mg/mL per minute or high-dose chemotherapy, and for pediatric patients who receive high-emetic-risk antineoplastic agents. For radiation-induced nausea and vomiting, adjustments were made to anatomic regions, risk levels, and antiemetic administration schedules. Rescue therapy alone is now recommended for low-emetic-risk radiation therapy. The Expert Panel reiterated the importance of using the most effective antiemetic regimens that are appropriate for antineoplastic agents or radiotherapy being administered. Such regimens should be used with initial treatment, rather than first assessing the patient’s emetic response with less-effective treatment. Additional information is available at www.asco.org/supportive-care-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Paul J. Hesketh
- Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington; Kimberly Noonan, Dana-Farber Cancer Institute, Boston, MA; Mark G. Kris, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch and Stacie B. Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill; Sally Y. Barbour, Duke University Medical Center, Durham, NC; Kari Bohlke and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria; Michael A. Danso, Virginia Oncology Associates, Virginia Beach; Michael A
| | - Mark G. Kris
- Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington; Kimberly Noonan, Dana-Farber Cancer Institute, Boston, MA; Mark G. Kris, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch and Stacie B. Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill; Sally Y. Barbour, Duke University Medical Center, Durham, NC; Kari Bohlke and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria; Michael A. Danso, Virginia Oncology Associates, Virginia Beach; Michael A
| | - Ethan Basch
- Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington; Kimberly Noonan, Dana-Farber Cancer Institute, Boston, MA; Mark G. Kris, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch and Stacie B. Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill; Sally Y. Barbour, Duke University Medical Center, Durham, NC; Kari Bohlke and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria; Michael A. Danso, Virginia Oncology Associates, Virginia Beach; Michael A
| | - Kari Bohlke
- Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington; Kimberly Noonan, Dana-Farber Cancer Institute, Boston, MA; Mark G. Kris, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch and Stacie B. Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill; Sally Y. Barbour, Duke University Medical Center, Durham, NC; Kari Bohlke and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria; Michael A. Danso, Virginia Oncology Associates, Virginia Beach; Michael A
| | - Sally Y. Barbour
- Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington; Kimberly Noonan, Dana-Farber Cancer Institute, Boston, MA; Mark G. Kris, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch and Stacie B. Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill; Sally Y. Barbour, Duke University Medical Center, Durham, NC; Kari Bohlke and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria; Michael A. Danso, Virginia Oncology Associates, Virginia Beach; Michael A
| | - Rebecca Anne Clark-Snow
- Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington; Kimberly Noonan, Dana-Farber Cancer Institute, Boston, MA; Mark G. Kris, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch and Stacie B. Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill; Sally Y. Barbour, Duke University Medical Center, Durham, NC; Kari Bohlke and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria; Michael A. Danso, Virginia Oncology Associates, Virginia Beach; Michael A
| | - Michael A. Danso
- Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington; Kimberly Noonan, Dana-Farber Cancer Institute, Boston, MA; Mark G. Kris, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch and Stacie B. Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill; Sally Y. Barbour, Duke University Medical Center, Durham, NC; Kari Bohlke and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria; Michael A. Danso, Virginia Oncology Associates, Virginia Beach; Michael A
| | - Kristopher Dennis
- Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington; Kimberly Noonan, Dana-Farber Cancer Institute, Boston, MA; Mark G. Kris, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch and Stacie B. Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill; Sally Y. Barbour, Duke University Medical Center, Durham, NC; Kari Bohlke and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria; Michael A. Danso, Virginia Oncology Associates, Virginia Beach; Michael A
| | - L. Lee Dupuis
- Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington; Kimberly Noonan, Dana-Farber Cancer Institute, Boston, MA; Mark G. Kris, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch and Stacie B. Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill; Sally Y. Barbour, Duke University Medical Center, Durham, NC; Kari Bohlke and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria; Michael A. Danso, Virginia Oncology Associates, Virginia Beach; Michael A
| | - Stacie B. Dusetzina
- Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington; Kimberly Noonan, Dana-Farber Cancer Institute, Boston, MA; Mark G. Kris, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch and Stacie B. Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill; Sally Y. Barbour, Duke University Medical Center, Durham, NC; Kari Bohlke and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria; Michael A. Danso, Virginia Oncology Associates, Virginia Beach; Michael A
| | - Cathy Eng
- Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington; Kimberly Noonan, Dana-Farber Cancer Institute, Boston, MA; Mark G. Kris, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch and Stacie B. Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill; Sally Y. Barbour, Duke University Medical Center, Durham, NC; Kari Bohlke and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria; Michael A. Danso, Virginia Oncology Associates, Virginia Beach; Michael A
| | - Petra C. Feyer
- Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington; Kimberly Noonan, Dana-Farber Cancer Institute, Boston, MA; Mark G. Kris, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch and Stacie B. Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill; Sally Y. Barbour, Duke University Medical Center, Durham, NC; Kari Bohlke and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria; Michael A. Danso, Virginia Oncology Associates, Virginia Beach; Michael A
| | - Karin Jordan
- Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington; Kimberly Noonan, Dana-Farber Cancer Institute, Boston, MA; Mark G. Kris, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch and Stacie B. Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill; Sally Y. Barbour, Duke University Medical Center, Durham, NC; Kari Bohlke and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria; Michael A. Danso, Virginia Oncology Associates, Virginia Beach; Michael A
| | - Kimberly Noonan
- Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington; Kimberly Noonan, Dana-Farber Cancer Institute, Boston, MA; Mark G. Kris, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch and Stacie B. Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill; Sally Y. Barbour, Duke University Medical Center, Durham, NC; Kari Bohlke and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria; Michael A. Danso, Virginia Oncology Associates, Virginia Beach; Michael A
| | - Dee Sparacio
- Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington; Kimberly Noonan, Dana-Farber Cancer Institute, Boston, MA; Mark G. Kris, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch and Stacie B. Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill; Sally Y. Barbour, Duke University Medical Center, Durham, NC; Kari Bohlke and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria; Michael A. Danso, Virginia Oncology Associates, Virginia Beach; Michael A
| | - Mark R. Somerfield
- Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington; Kimberly Noonan, Dana-Farber Cancer Institute, Boston, MA; Mark G. Kris, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch and Stacie B. Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill; Sally Y. Barbour, Duke University Medical Center, Durham, NC; Kari Bohlke and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria; Michael A. Danso, Virginia Oncology Associates, Virginia Beach; Michael A
| | - Gary H. Lyman
- Paul J. Hesketh, Lahey Hospital and Medical Center, Burlington; Kimberly Noonan, Dana-Farber Cancer Institute, Boston, MA; Mark G. Kris, Memorial Sloan Kettering Cancer Center, New York, NY; Ethan Basch and Stacie B. Dusetzina, University of North Carolina at Chapel Hill, Chapel Hill; Sally Y. Barbour, Duke University Medical Center, Durham, NC; Kari Bohlke and Mark R. Somerfield, American Society of Clinical Oncology, Alexandria; Michael A. Danso, Virginia Oncology Associates, Virginia Beach; Michael A
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Doggrell SA. Granisetron in the treatment of chemotherapy-induced nausea and vomiting (CINV) – is there still a role after comparison with palonosetron? Expert Opin Pharmacother 2017; 18:1019-1026. [DOI: 10.1080/14656566.2017.1342809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sheila A Doggrell
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
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Schnadig ID, Agajanian R, Dakhil C, Gabrail N, Vacirca J, Taylor C, Wilks S, Braun E, Mosier MC, Geller RB, Schwartzberg L, Vogelzang N. APF530 versus ondansetron, each in a guideline-recommended three-drug regimen, for the prevention of chemotherapy-induced nausea and vomiting due to anthracycline plus cyclophosphamide-based highly emetogenic chemotherapy regimens: a post hoc subgroup analysis of the Phase III randomized MAGIC trial. Cancer Manag Res 2017; 9:179-187. [PMID: 28579832 PMCID: PMC5446958 DOI: 10.2147/cmar.s129059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND APF530, a novel extended-release granisetron injection, was superior to ondansetron in a guideline-recommended three-drug regimen in preventing delayed-phase chemotherapy-induced nausea and vomiting (CINV) among patients receiving highly emetogenic chemotherapy (HEC) in the double-blind Phase III Modified Absorption of Granisetron In the prevention of CINV (MAGIC) trial. PATIENTS AND METHODS This MAGIC post hoc analysis evaluated CINV prevention efficacy and safety of APF530 versus ondansetron, each with fosaprepitant and dexamethasone, in patient subgroup receiving an anthracycline plus cyclophosphamide (AC) regimen. Patients were randomized 1:1 to APF530 500 mg subcutaneously (granisetron 10 mg) or ondansetron 0.15 mg/kg intravenously (IV) (≤16 mg); stratification was by planned cisplatin ≥50 mg/m2 (yes/no). Patients were to receive fosaprepitant 150 mg IV and dexamethasone 12 mg IV on day 1, then dexamethasone 8 mg orally once daily on day 2 and twice daily on days 3 and 4. Patients were mostly younger females (APF530 arm, mean age 54.1 years, female, 99.3%; ondansetron arm, 53.8 years, female 98.3%). The primary end point was delayed-phase (>24-120 hours) complete response (CR). RESULTS APF530 versus ondansetron regimens achieved numerically better CINV control in delayed and overall (0-120 hours) phases for CR, complete control, total response, rescue medication use, and proportion with no nausea. APF530 trends are consistent with the overall population, although not statistically superior given the underpowered AC subgroup analysis. The APF530 regimen in this population was generally well tolerated, with safety comparable to that of the overall population. CONCLUSION APF530 plus fosaprepitant and dexamethasone effectively prevented CINV among patients receiving AC-based HEC, a large subgroup in whom CINV control has traditionally been challenging.
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Affiliation(s)
| | | | | | | | | | | | - Sharon Wilks
- Cancer Care Centers of South Texas, San Antonio, TX
| | | | - Michael C Mosier
- Biostatistics, EMB Statistical Solutions, LLC, Overland Park, KS
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Granisetron Extended-Release Injection: A Review in Chemotherapy-Induced Nausea and Vomiting. Drugs 2017; 76:1779-1786. [PMID: 27915445 DOI: 10.1007/s40265-016-0664-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
An extended-release (ER) subcutaneously injectable formulation of the first-generation 5-HT3 receptor antagonist granisetron is now available in the USA (Sustol®), where it is indicated for the prevention of acute and delayed chemotherapy-induced nausea and vomiting (CINV) following moderately emetogenic chemotherapy (MEC) or anthracycline and cyclophosphamide combination chemotherapy regimens in adults. Granisetron ER is administered as a single subcutaneous injection and uses an erosion-controlled drug-delivery system to allow prolonged granisetron release. Primary endpoint data from phase III studies after an initial cycle of chemotherapy indicate that, when used as part of an antiemetic regimen, granisetron ER injection is more effective than intravenous ondansetron in preventing delayed CINV following highly emetogenic chemotherapy (HEC); is noninferior to intravenous palonosetron in preventing both acute CINV following MEC or HEC and delayed CINV following MEC; and is similar, but not superior, to palonosetron in preventing delayed CINV following HEC. The benefits of granisetron ER were seen in various patient subgroups, including those receiving anthracycline plus cyclophosphamide-based HEC, and (in an extension of one of the studies) over multiple MEC or HEC cycles. Granisetron ER injection is generally well tolerated, with an adverse event profile similar to that of ondansetron or palonosetron. Thus, granisetron ER injection expands the options for preventing both acute and delayed CINV in adults with cancer receiving MEC or anthracycline plus cyclophosphamide-based HEC.
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Rashad N, Abdel-Rahman O. Differential clinical pharmacology of rolapitant in delayed chemotherapy-induced nausea and vomiting (CINV). Drug Des Devel Ther 2017; 11:947-954. [PMID: 28392676 PMCID: PMC5373840 DOI: 10.2147/dddt.s108872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Rolapitant is a highly selective neurokinin-1 receptor antagonist, orally administered for a single dose of 180 mg before chemotherapy with granisetron D1, dexamethasone 8 mg BID on day 2-4. It has a unique pharmacological characteristic of a long plasma half-life (between 163 and 183 hours); this long half-life makes a single use sufficient to cover the delayed emesis risk period. No major drug-drug interactions between rolapitant and dexamethasone or other cytochrome P450 inducers or inhibitors were observed. The clinical efficacy of rolapitant was studied in two phase III trials in highly emetogenic chemotherapy and in one clinical trial in moderately emetogenic chemotherapy. The primary endpoint was the proportion of patients achieving a complete response (defined as no emesis or use of rescue medication) in the delayed phase (>24-120 hours after chemotherapy). In comparison to granisetron (10 μg/kg intravenously) and dexamethasone (20 mg orally) on day 1, and dexamethasone (8 mg orally) twice daily on days 2-4 and placebo, rolapitant showed superior efficacy in the control of delayed and overall emesis. This review aims at revising the pharmacological characteristics of rolapitant, offering an updated review of the available clinical efficacy and safety data of rolapitant in different clinical settings, highlighting the place of rolapitant in the management of chemotherapy-induced nausea and vomiting (CINV) among currently available guidelines, and exploring the future directions of CINV management.
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Affiliation(s)
- Noha Rashad
- Medical Oncology Department, Maadi Armed Forces Hospital
| | - Omar Abdel-Rahman
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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2016 Updated MASCC/ESMO Consensus Recommendations: Prevention of Nausea and Vomiting Following High Emetic Risk Chemotherapy. Support Care Cancer 2016; 25:277-288. [DOI: 10.1007/s00520-016-3313-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
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Schnadig ID, Agajanian R, Dakhil C, Gabrail NY, Smith RE, Taylor C, Wilks ST, Schwartzberg LS, Cooper W, Mosier MC, Payne JY, Klepper MJ, Vacirca JL. APF530 (granisetron injection extended-release) in a three-drug regimen for delayed CINV in highly emetogenic chemotherapy. Future Oncol 2016; 12:1469-81. [DOI: 10.2217/fon-2016-0070] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: APF530, extended-release granisetron, provides sustained release for ≥5 days for acute- and delayed-phase chemotherapy-induced nausea and vomiting (CINV). We compared efficacy and safety of APF530 versus ondansetron for delayed CINV after highly emetogenic chemotherapy (HEC), following a guideline-recommended three-drug regimen. Methods: HEC patients received APF530 500 mg subcutaneously or ondansetron 0.15 mg/kg intravenously, with dexamethasone and fosaprepitant. Primary end point was delayed-phase complete response (no emesis or rescue medication). Results: A higher percentage of APF530 versus ondansetron patients had delayed-phase complete response (p = 0.014). APF530 was generally well tolerated; treatment-emergent adverse event incidence was similar across arms, mostly mild-to-moderate injection-site reactions. Conclusion: APF530 versus the standard three-drug regimen provided superior control of delayed-phase CINV following HEC. ClinicalTrials.gov : NCT02106494.
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Affiliation(s)
- Ian D Schnadig
- Compass Oncology, US Oncology Research, Tualatin, OR, USA
| | - Richy Agajanian
- The Oncology Institute of Hope & Innovation, Whittier, CA, USA
| | | | | | | | | | - Sharon T Wilks
- Cancer Care Centers of South Texas, San Antonio, TX, USA
| | | | | | | | - J Yvette Payne
- Heron Therapeutics, Inc., San Diego, CA, USA (at time of study)
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Boccia R, O'Boyle E, Cooper W. Randomized phase III trial of APF530 versus palonosetron in the prevention of chemotherapy-induced nausea and vomiting in a subset of patients with breast cancer receiving moderately or highly emetogenic chemotherapy. BMC Cancer 2016; 16:166. [PMID: 26921245 PMCID: PMC4769519 DOI: 10.1186/s12885-016-2186-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 02/16/2016] [Indexed: 11/23/2022] Open
Abstract
Background APF530 provides controlled, sustained-release granisetron for preventing acute (0–24 h) and delayed (24–120 h) chemotherapy-induced nausea and vomiting (CINV). In a phase III trial, APF530 was noninferior to palonosetron in preventing acute CINV following single-dose moderately (MEC) or highly emetogenic chemotherapy (HEC) and delayed CINV in MEC (MEC and HEC defined by Hesketh criteria). This exploratory subanalysis was conducted in the breast cancer subpopulation. Methods Patients were randomized to subcutaneous APF530 250 or 500 mg (granisetron 5 or 10 mg) or intravenous palonosetron 0.25 mg during cycle 1. Palonosetron patients were randomized to APF530 for cycles 2 to 4. The primary efficacy end point was complete response (CR, no emesis or rescue medication) in cycle 1. Results Among breast cancer patients (n = 423 MEC, n = 185 HEC), > 70 % received anthracycline-containing regimens in each emetogenicity subgroup. There were no significant between-group differences in CRs in cycle 1 for acute (APF530 250 mg: MEC 71 %, HEC 77 %; 500 mg: MEC 73 %, HEC 73 %; palonosetron: MEC 68 %, HEC 66 %) and delayed (APF530 250 mg: MEC 46 %, HEC 58 %; 500 mg: MEC 48 %, HEC 63 %; palonosetron: MEC 52 %, HEC 52 %) CINV. There were no significant differences in within-cycle CRs between APF530 doses for acute and delayed CINV in MEC or HEC in cycles 2 to 4; CRs trended higher in later cycles, with no notable differences in adverse events between breast cancer and overall populations. Conclusions APF530 effectively prevented acute and delayed CINV over 4 chemotherapy cycles in breast cancer patients receiving MEC or HEC. Trial registration Clinicaltrials.gov identifier: NCT00343460 (June 22, 2006).
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Affiliation(s)
- Ralph Boccia
- Center for Cancer and Blood Disorders, 6410 Rockledge Drive #660, Bethesda, MD, 20819, USA.
| | - Erin O'Boyle
- FibroGen, Inc, 409 Illinois Street, San Francisco, CA, 94158, USA
| | - William Cooper
- TFS, Inc, 212 Carnegie Center, Suite 208, Princeton, NJ, 08540, USA
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Navari RM. The safety of antiemetic medications for the prevention of chemotherapy-induced nausea and vomiting. Expert Opin Drug Saf 2016; 15:343-56. [DOI: 10.1517/14740338.2016.1135899] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Navari RM. 5-HT3 receptors as important mediators of nausea and vomiting due to chemotherapy. BIOCHIMICA ET BIOPHYSICA ACTA-BIOMEMBRANES 2015; 1848:2738-46. [DOI: 10.1016/j.bbamem.2015.03.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 02/26/2015] [Accepted: 03/20/2015] [Indexed: 02/07/2023]
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Raftopoulos H, Boccia R, Cooper W, O'Boyle E, Gralla RJ. Slow-release granisetron (APF530) versus palonosetron for chemotherapy-induced nausea/vomiting: analysis by American Society of Clinical Oncology emetogenicity criteria. Future Oncol 2015; 11:2541-51. [PMID: 26289588 DOI: 10.2217/fon.15.185] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND APF530 is a novel sustained-release formulation of granisetron. In a Phase III trial, APF530 500 mg was noninferior to palonosetron 0.25 mg in preventing acute chemotherapy-induced nausea and vomiting (CINV) after moderately (MEC) or highly emetogenic chemotherapy (HEC) and delayed CINV after MEC, but not superior in preventing delayed CINV after HEC. Emetogenicity was classified by Hesketh criteria; this reanalysis uses newer American Society of Clinical Oncology criteria. METHODS Complete responses (no emesis or rescue medication) after cycle one were reanalyzed after reclassification of MEC and HEC by American Society of Clinical Oncology criteria. RESULTS APF530 maintained noninferiority to palonosetron. CONCLUSION Single-dose APF530 is a promising alternative to palonosetron for preventing acute and delayed CINV after MEC or HEC. The Clinicaltrials.gov identifier for this study is NCT00343460.
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Affiliation(s)
- Harry Raftopoulos
- Merck & Co, RY34-B2114, Mailstop B270, 126 East Lincoln Avenue Rahway, NJ 07065, USA.,At the time of writing this article: Hofstra North Shore-LIJ School of Medicine, 450 Lakeville Road, Lake Success, NY 11042, USA
| | - Ralph Boccia
- Center for Cancer & Blood Disorders, 6410 Rockledge Drive #660, Bethesda, MD 20819, USA
| | - William Cooper
- TFS International, 70 Church Street, Flemington, NJ 08822, USA
| | - Erin O'Boyle
- FibroGen, Inc., 409 Illinois Street, San Francisco, CA 94158, USA
| | - Richard J Gralla
- Albert Einstein College of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY 10461, USA
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Gabrail N, Yanagihara R, Spaczyński M, Cooper W, O’Boyle E, Smith C, Boccia R. Pharmacokinetics, safety, and efficacy of APF530 (extended-release granisetron) in patients receiving moderately or highly emetogenic chemotherapy: results of two Phase II trials. Cancer Manag Res 2015; 7:83-92. [PMID: 25834466 PMCID: PMC4370683 DOI: 10.2147/cmar.s72626] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Despite advances with new therapies, a significant proportion of patients (>30%) suffer delayed-onset chemotherapy-induced nausea and vomiting (CINV) despite use of antiemetics. APF530 is a sustained-release subcutaneous (SC) formulation of granisetron for preventing CINV. APF530 pharmacokinetics, safety, and efficacy were studied in two open-label, single-dose Phase II trials (C2005-01 and C2007-01, respectively) in patients receiving moderately emetogenic chemotherapy or highly emetogenic chemotherapy. METHODS In C2005-01, 45 patients received APF530 250, 500, or 750 mg SC (granisetron 5, 10, or 15 mg, respectively). In C2007-01, 35 patients were randomized to APF530 250 or 500 mg SC. Injections were given 30 to 60 minutes before single-day moderately emetogenic chemotherapy or highly emetogenic chemotherapy. Plasma granisetron was measured from predose to 168 hours after study drug administration. Safety and efficacy were also evaluated. RESULTS APF530 pharmacokinetics were dose proportional, with slow absorption and elimination of granisetron after a single SC dose. Median time to maximum plasma concentration and half-life were similar for APF530 250 and 500 mg in both trials, with no differences between the groups receiving moderately and highly emetogenic chemotherapy. Exposure to granisetron was maintained at a therapeutic level over the delayed-onset phase, at least 168 hours. Adverse events in both trials were as expected for granisetron; injection site reactions (eg, erythema and induration) were predominantly mild and seen in ≤20% of patients. Complete responses (no emesis, with no rescue medication) were obtained in the acute, delayed, and overall phases in ≥80% and ≥75% of patients in both trials with the 250 and 500 mg doses, respectively. CONCLUSION After a single injection of APF530, there were dose-proportional pharmacokinetics and sustained concentrations of granisetron over 168 hours. The 250 and 500 mg doses were well tolerated and maintained therapeutic granisetron levels for ≥5 days.
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Affiliation(s)
| | | | - Marek Spaczyński
- Department of Gynecology, Obstetrics and Gynecologic Oncology, University of Medical Sciences, Poznan, Poland
| | | | | | | | - Ralph Boccia
- Center for Cancer and Blood Disorders, Bethesda, MD, USA
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Ottoboni T, Gelder MS, O'Boyle E. Biochronomer™ technology and the development of APF530, a sustained release formulation of granisetron. J Exp Pharmacol 2014; 6:15-21. [PMID: 27186139 PMCID: PMC4863535 DOI: 10.2147/jep.s68880] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Granisetron and other 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists are first-line agents for preventing chemotherapy-induced nausea and vomiting (CINV). Current treatment guidelines prefer the longer-acting agent, palonosetron, for CINV prevention in some chemotherapy regimens. A new granisetron formulation, APF530, has been developed as an alternative long-acting agent. APF530 utilizes Biochronomer™ technology to formulate a viscous tri(ethylene glycol) poly(orthoester)-based formulation that delivers – by single subcutaneous (SC) injection – therapeutic granisetron concentrations over 5 days. The poly(orthoester) polymer family contain an orthoester linkage; these bioerodible polymer systems are specifically designed for controlled, sustained drug delivery. Pharmacokinetics and pharmacodynamics of APF530 250, 500, or 750 mg SC (granisetron 5, 10, or 15 mg, respectively) administered 30–60 minutes before chemotherapy were evaluated in two Phase II trials in cancer patients receiving moderately (MEC) or highly (HEC) emetogenic chemotherapy. Pharmacokinetics were dose proportional, with slow granisetron absorption and elimination. Both trials demonstrated similar results for median half-life, time to maximum concentration, and exposure for APF530 250 and 500 mg, with no differences between patients receiving MEC or HEC. A randomized Phase III trial demonstrated noninferiority of APF530 500 mg SC (granisetron 10 mg) to intravenous palonosetron 0.25 mg in preventing CINV in patients receiving MEC or HEC in acute (0–24 hours) and delayed (24–120 hours) settings, with activity over 120 hours. Mean maximum granisetron plasma concentrations were 10.8 and 17.8 ng/mL, and mean half-lives were 30.8 and 35.9 hours after SC administration of APF530 250 and 500 mg, respectively. Therapeutic granisetron concentrations were maintained for greater than 120 hours (5 days) in both APF530 dose groups. These data suggest that APF530 – an SC-administered formulation of granisetron delivered via Biochronomer technology – represents an effective treatment option for the prevention of both acute and delayed CINV in patients receiving either MEC or HEC.
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