Abstract
COMPARATIVE STUDY BETWEEN THE CLINICAL EFFECT OF PALONOSETRON AND GRANISETRON AS ANTIEMETIC THERAPY IN COMBINATION WITH DEXAMETHASONE IN PATIENTS RECEIVING HIGHLY EMETOGENIC CHEMOTHERAPY REGIMENS

Mohamed Mahrous*, Gamal El-azab and Hisham Tawfik

ABSTRACT

Background: Chemotherapy-induced nausea and vomiting (CINV) are considered the main fear for both oncologists and patients. It dramatically affects the quality of life, especially food intake and nutritional status. we can observe CINV in highly emetogenic chemotherapy (HEC) such as AC protocol in breast cancer patients or cisplatin-based regimens in other cancer types. This study aimed to evaluate the antiemetic efficacy of palonosetron (PALO) over Granisetron (GRA) in combination with dexamethasone for multiple high emetogenic risk (HER) anti-cancer agents, especially in chemotherapy regimens in Egyptian breast cancer patients and Cisplatin-based regimens in other diseases. Patients and Methods: All patients received dexamethasone in combination with the 5-HT3 receptor antagonist. Patients' clinical and biochemical characteristics were recorded, and blood samples were drawn to monitor serum substance P and serotonin in correlation with chemotherapy-induced nausea and vomiting (CINV). MASCC antiemetic tool in the acute phase (0hr-24hr) and delayed phase (24hr-120hr) was used to evaluate patient outcomes in both stages after each chemotherapy cycle. Results: In (PALO) group, only 7.84% of patients showed acute vomiting, and 11.76 % showed acute nausea, whereas 43.75 % of patients showed acute vomiting and 89.06 % showed acute nausea in (GRA) group (P<0.0001). For delayed CINV, 23.53 % of patients showed delayed vomiting, and 47.06 % showed delayed nausea in (PALO) group, while 82.81 % of patients showed delayed emesis, and 92.19 % showed delayed nausea in (GRA) group (P<0.0001). Besides that, 45.10% of patients in (PALO) required additional rescue medications (dompridone 10 mg oral three times per day plus trimibutine 200mg oral three times per week both for five days), while 95.24 % in the (GRA) group used the same medications. Adverse events of both antiemetic drugs (PALO and GRA) were mostly mild to moderate, with relatively low rates among the two groups. Conclusion: Palonosetron, combined with dexamethasone, is more effective than Granisetron and dexamethasone combination against both acute and delayed emesis induced by highly emetogenic cisplatin-based chemotherapy and highly emetogenic combination of cyclophosphamide and anthracyclines (AC).

Keywords: CINV, HEC, Palonosetron, Granisetron, Supportive care, Pharmacokinetics, cancer pharmacology.


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