Likun, Z., Xiang, J., Yi, B., Xin, D., & Tao, Z.L. (2011). A systematic review and meta-analysis of intravenous palonosetron in the prevention of chemotherapy-induced nausea and vomiting in adults. Oncologist, 16, 207–216.

To evaluate the effectiveness and adverse effects of palonosetron in prevention of chemotherapy-induced nausea and vomiting (CINV)

Databases searched were Medline, Embase, Chinese VIP database, Evidence-Based Medicine Review, Cochran Central Register, Current Controlled Trials, National Research Register, and Clinicaltrials.gov.

Search keywords were palonosetron, chemotherapy-induced nausea and/or vomiting, CINV.

Studies were included if they were randomized, controlled trials (RCTs) that compared palonosetron with first generation 5-HT₃ receptor antagonists (RAs).

Studies were excluded if they involved pediatric patients.

An initial 235 references were identified. Eight RCTs were identified for inclusion. Studies were evaluated in terms of randomization, blinding, allocation concealment, crossover design, and intention to treat analysis.

The final sample included eight RCTs involving 3,592 patients receiving highly or moderately emetogenic chemotherapy.

In comparing the effectiveness of palonosetron with first-generation 5-HT₃ RAs for acute CINV

• Palonosetron reduced the risk of acute CINV by 24% (p = 0.0003)
• No difference was found between 0.25-mg and 0.75-mg palonosetron doses.

In comparing the effectiveness of palonosetron with first-generation 5-HT₃ RAs for delayed CINV, both the 0.25-mg and 0.75-mg palonosetron doses yielded better prevention of delayed CINV (p < 0.00001).

Studies that included dexamethasone (two trials) reported that dexamethasone plus palonosetron reduced the risk of CINV by 38%–40% (p < 0.00001).

The 0.75-mg palonosetron dose was associated with a higher risk of constipation than lower-dose palonosetron or first-generation medications (p = 0.01).

Meta-analysis demonstrated that palonosetron was more effective in risk reduction for both acute and delayed CINV than first-generation 5-HT₃ RAs. This effect was seen with both 0.25- and 0.75-mg dosages, and with or without concomitant use of dexamethasone. A 0.75-mg dose of palonosetron was associated with more constipation.

A limited number of studies were used in some subgroup analysis, and no studies looked at lower-dose palonosetron and dexamethasone compared to first-generation drugs. This research is warranted, because lower dosages are associated with less constipation.

Palonosetron is a safe and effective alternative for prevention of CINV. Nurses need to be aware of the potential for constipation with higher dosages, particularly in patients with other treatments that affect bowel function.