Abstract
Chemotherapy-induced nausea and vomiting is a serious adverse side-effect of anthracycline-based chemotherapy regimens, in patients with breast cancer. A combination of three drugs, 5-hydroxytryptamine (5-HT3) receptor antagonist, aprepitant and dexamethasone, is recommended for antiemetic therapy. Palonosetron (PALO), a novel 5-HT3 receptor antagonist has been identified to be effective against delayed nausea and vomiting. In this study, the results of PALO for patients who received anthracycline-based chemotherapy were compared with that of granisetron (GRA) using a crossover study design. This study evaluated the efficacy of antiemetics in the first cycle of chemotherapy, as well as the second and third cycles. A total of 21 patients and 19 patients were assigned to PALO and GRA treatment groups during the first cycle of chemotherapy, respectively. The patients switched to the other antiemetic drug for the second chemotherapy cycle (PALO followed by GRA or GRA followed by PALO). The patients could select PALO or GRA antiemetics for the third cycle, according to their preference. A total of 21 patients selected PALO and 18 patients selected GRA in the third cycle, and one patient was withdrawn from the study as their third cycle questionnaire was not obtained. No significant differences between PALO and GRA were identified in first and second cycles. However, during the third cycle, a significant difference was observed in acute-phase complete control of emetic events between the PALO and GRA groups, which was defined as no emetic episode, no additional antiemetic treatment and no more than mild nausea, between PALO and GRA. These results demonstrated that changing antiemetics may affect the efficacy of antiemetics. This study indicates that alteration of antiemetic regimens, including drug combination and order, may improve the efficacy of antiemetic treatment.
Highlights
Combination chemotherapy regimens for breast cancer, which include anthracycline drugs and cyclophosphamide [doxorubicin plus cyclophosphamide (AC); epirubicin plus cyclophosphamide (EC); and fluorouracil, epirubicin plus cyclophosphamide (FEC)], are classified as exhibiting a high risk of emesis by the National Comprehensive Cancer Network in 2012 and American Society of Clinical Oncology guidelines [1,2]
The efficacy of the novel 5‐HT3 receptor antagonist, PALO, was compared with that of the conventional drug granisetron (GRA) for the antiemetic treatment of breast cancer patients treated with highly emetic therapeutic regimens that involved anthracyclines and cyclophosphamide
For the second cycle of treatment, patients switched to the other medication (GRA followed by PALO or PALO followed by GRA)
Summary
Combination chemotherapy regimens for breast cancer, which include anthracycline drugs and cyclophosphamide [doxorubicin plus cyclophosphamide (AC); epirubicin plus cyclophosphamide (EC); and fluorouracil, epirubicin plus cyclophosphamide (FEC)], are classified as exhibiting a high risk of emesis by the National Comprehensive Cancer Network in 2012 and American Society of Clinical Oncology guidelines [1,2]. It is recommended in these guidelines to use a combination of three drugs [5‐hydroxytryptamine (5‐HT3) receptor antagonist, aprepitant (APR) and dexamethasone (DEX)] for antiemetic treatment [1,2]. A novel 5‐HT3 receptor antagonist, palonosetron (PALO), has been identified. PALO has demonstrated effectiveness against delayed emetic events [3,4,5]. PALO and APR excel in the prevention of delayed nausea and vomiting. No studies regarding the comparative efficacy of PALO and the conventional 5‐HT3 receptor antagonists used in combination with APR have been reported. The efficacy of the novel 5‐HT3 receptor antagonist, PALO, was compared with that of the conventional drug granisetron (GRA) for the antiemetic treatment of breast cancer patients treated with highly emetic therapeutic regimens that involved anthracyclines and cyclophosphamide. No studies have investigated the efficacy of such drugs, following the second cycle and, in the present study, the efficacy of the drugs were evaluated following the second cycle
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