Palonosetron for prevention of acute and delayed nausea and vomiting induced by moderately emetogenic adjuvant folfox-4 regimen in colorectal cancer (CRC) patients: A phase II study of the Gruppo Oncologico dell’ Italia Meridionale (GOIM)

Abstract

IntroductionFolfox-4 is the standard adjuvant treatment in stage III colon cancer and is also recommended in high-risk stage II colon cancer. Oxaliplatin-based regimens are considered moderately emetogenic therapies. Palonosetron, a new selective inhibitor of 5-HT3 receptors, in combination with dexhametasone showed a high antiemetic activity in pivotal trials enrolling patients treated with moderately or high emetogenic regimens. Considering these data, the GOIM started a multicentre phase II trial aiming to evaluate the activity and safety of palonosetron plus dexhametasone in patients affected by radically resected colorectal cancer and treated with adjuvant folfox-4.Materials and methodsPatients with stage III or high-risk stage II colorectal cancer and receiving folfox-4 as adjuvant treatment entered into the trial. Informed written consent was required. A single pretreatment dose of palonosetron 0.25mg (intravenous) i.v. followed by dexamethasone 8mg i.v. was administered. Nausea and vomiting were evaluated on day 1 and over the following 4d, with a patient diary including vomiting episodes, daily nausea and use of rescue medications. The main end-point of the study was the absence of vomiting in the entire period (5d) at the first cycle. The absence of moderately or severe nausea and vomiting on days 1–5 was the secondary end-point. Adverse events were evaluated according to the NCI-CTC criteria.ResultsEighty-five patients entered into the study and were all evaluable for activity and safety. The absence of vomiting on the study period (days 1–5) was observed in 82 (96.5%) patients: one patient on the 1st and two on the 2nd day experienced mild vomiting. With respect to the secondary end-point, the complete control during the acute phase was 96.5% while during the late phase was 92%. The complete responses during the acute and delayed phases were 99% and 89.5%, respectively. The main side-effects (G1 grade) were: constipation 13%, headache 10%, vertigo and insomnia 2%.ConclusionsPalonosetron is a very active antiemetic drug for the prevention of nausea and vomiting induced by folfox-4 regimen.