Saito, M., & Tsukuda, M. (2010). Review of palonosetron: Emerging data distinguishing it as a novel 5 HT(3) receptor antagonist for chemotherapy induced nausea and vomiting. Expert Opinion on Pharmacotherapy, 11, 1003–1014.

This article provided a review of the history of antiemetic development and use, a brief overview of relevant professional guidelines, and recent research on pharmacokinetics and outcomes with palonosetron. A meta-analysis on studies with two different doses of palonosetron was provided. No specific search strategy or research evaluation approach was reported.

• Palonosetron has a longer plasma half-life (approximately 40 hours) than other 5-HT₃ receptor antagonists (approximately 5–12 hours half-life).
• Palonosetron has a much higher bonding affinity for the 5-HT₃ receptor.
• Additional less clear differences are seen at the cellular level with palonosetron.
• Review of findings with palonosetron with multiday chemotherapy have shown complete response rates that are about twice that of historically reported prevention rates with other medications.
• Various research studies of palonosetron were reviewed. No firm conclusions were drawn regarding superiority of any particular regimen.

• Little research and description of rescue therapy and the most effective rescue approaches were provided.
• A lack of clarity exists in the border between acute and delayed CINV, particularly with multiday therapy.
• The most appropriate and effective dosage of palonosetron is controversial.
• Current guidelines related to CINV may need to be evaluated with the advent of new medications.

Pharmacokinetics and effects of palonosetron suggest it may have greater efficacy, particularly with delayed nausea and vomiting. This review points to a number of issues that should be considered in the design of future studies in this area.