Murakami, M., Hashimoto, H., Yamaguchi, K., Yamaguchi, I., Senba, S., & Siraishi, T. (2013). Effectiveness of palonosetron for preventing delayed chemotherapy-induced nausea and vomiting following moderately emetogenic chemotherapy in patients with gastrointestinal cancer. Supportive Care in Cancer, 22(4), 905–909. 

To determine the effectiveness of palonosetron when compared to granisetron in controlling nausea and vomiting in people with gastrointestinal cancer who were receiving moderately emetogenic chemotherapy

Patients with gastrointestinal cancer receiving their initial dose of induction chemotherapy (moderately emetogenic) either received 3 mg of granisetron or 0.75 mg of palonosetron on day 1 of treatment in addition to standard treatment (6.6 mg IV dexamethasone on day 1 and 8 mg oral dexamethasone on days 2 and 3). Effectiveness of the antiemetics was evaluated on day 5 by comparing occurrence of acute and delayed nausea and vomiting between the two groups.

• N = 92  
• MEAN AGE (whole sample) = 67.25 years (range = 37–86 years) 
• MALES: 69.5%, FEMALES: 30.4%
• KEY DISEASE CHARACTERISTICS: Gastrointestinal cancer
• OTHER KEY SAMPLE CHARACTERISTICS: Receiving moderately emetogenic chemotherapy

• SITE: Single-site  
• SETTING TYPE: Outpatient  
• LOCATION: Large cancer clinic in Japan

• PHASE OF CARE: Active antitumor treatment

Prospective observational design, no random assignment of conditions, and no blinding of conditions

The Multinational Association of Supportive Care in Cancer's (MASCC's) Antiemesis Tool (MAT) with additional items about anorexia added. The MAT contains eight items assessing acute and delayed nausea and vomiting and one item assessing anorexia. Participants were asked to complete this measure five days after receiving chemotherapy.

Overall nausea and delayed nausea were significantly lower in the palonosetron group as compared to the granisetron group (p  <  0.01). The differences between acute nausea, overall vomiting, delayed vomiting, and acute vomiting were not statistically significant.

Palonosetron effectively controls delayed nausea caused by moderately emetogenic chemotherapy as compared to granisetron in patients with gastrointestinal cancer.

• Small sample (< 100)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)

Palonosetron appears to be effective in controlling delayed nausea and would be a useful antiemetic to prescribe for those receiving regimens consisting of moderately emetogenic chemotherapy.