Feinberg, B., Gilmore, J., Haislip, S., Jackson, J., Jain, G., Balu, S., & Buchner, D. (2012). Impact of initiating antiemetic prophylaxis with palonosetron versus ondansetron on risk of uncontrolled chemotherapy-induced nausea and vomiting in patients with lung cancer receiving multi-day chemotherapy. Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer, 20(3), 615–623.

To examine the risk of uncontrolled chemotherapy-induced nausea and vomiting (CINV) among patients with lung cancer receiving multiday chemotherapy and ondansetron- or palonosetron-initiated prophylactic antiemetic regimens in a community oncology setting

The Georgia Cancer Specialists electronic medical records database was used to identify patients with lung cancer who received multiday cisplatin or carboplatin regimens with ondansetron or palonosetron on day 1 between April 1, 2006, and July 31, 2009. Uncontrolled CINV was identified. Risk for uncontrolled CINV, up to 7 days after last chemotherapy administration, was analyzed at cycle level using logistic regression.

• The study reported on 362 patients; 209 of these patients received a total of 702 cycles of palonosetron, and 153 patients received 515 cycles of ondansetron.
• The palonosetron group was significantly older than the ondansetron group (66.8 years old versus 63.9 years old [p < 0.01]).
• The palonosetron group was 54% female, and the ondansetron group was 53% female.    
• Patients were diagnosed with lung cancer, received multiday cisplatin or carboplatin regimens, and used palonosetron or ondansetron on day 1 (and did not receive aprepitant on day 1). The palonosetron group received antiemetics every other day, whereas patients in the ondansetron group received ondansetron every day except for the last day, in which they received palonosetron.
• The palonosetron group had a Charlson comorbidity index of 3.6 and the ondansetron group had a Charlson comorbidity index of 3.5.
• The palonosetron group included 25 patients with multicancer diagnoses and the ondansetron group included 27 patients with multicancer diagnoses.

This was a multi-site study based on electronic medical records data from Georgia Cancer Specialist, a community-based practice that included 30 offices and 46 medical oncologists throughout Georgia.

• Patients were in active treatment.
• This study has application to late effects and survivorship.

This was a retrospective descriptive study using data from an electronic medical records review.

The rate of uncontrolled CINV events measured from first chemotherapy agent administration of the cycle (start date) through 7 days after the last chemotherapy agent administration (end date) for

• Assessment of a CINV event using
  • ICD-9-CM codes 787, 787.01, 782.02, 787.03 (nausea/vomiting), and 265.51(dehydration).
  • CPT codes 09760, 90761, 96360, and 96361 (hydration).
• Rescue medications (NDC code for dexamethasone/Decadron, diphenhydramine/Benadryl, olanzapine/Zyprexa, promethazone/Phenergan, haloperidol/Haldol, prochlorperazine/Compazine, lorazepam/Ativan, or metoclopramide/Reglan).
• Nausea/vomiting hospitalizations.
• Oral antiemetic medications and administration of fosaprepitant and aprepitant.
• IV antiemetic therapy after last chemotherapy administration of the cycle.

Rescue antiemetic after the first day chemotherapy or IV antiemetic after the last chemotherapy administration date were considered as nonprophylactic use.

• Overall, 273 uncontrolled CINV events were found during 702 platinum cycles in the palonosetron cohort (38.9%) and 455 events were found during 515 cycles (88.4%) in the ondansetron cohort (p < 0.01).
• Palonosetron cycles had 63% lower risk for uncontrolled CINV events versus ondansetron cycles (OR = 0.37, p < 0.01).
• Subanalysis by chemotherapy agents supported overall analysis (cisplatin OR = 0.09, p < 0.01, carboplatin OR = 0.46, p < 0.01).

Among patients with lung cancer receiving multiday chemotherapy cycles, administration of palonosetron on day 1 was associated with a significantly lower risk for uncontrolled CINV events versus ondansetron-initiated chemotherapy cycles.

• No appropriate control group was included.
• Retrospective EMR reviews introduce some limitations. For example, CINV events or hospitalization may have been underestimated, and at-home antiemetic use is not detectable.
• The palonosetron group was significantly older, which may have lowered CINV risk. Significantly more patients in the palonosetron group received moderately emetogenic chemotherapy than in the ondonsetron group, which may have influenced the comparison between the two.
• Race, smoking status, and alcohol use were not assessed.

For the patients receiving multiple day, platinum based chemotherapy for the treatment of lung cancer, every-other-day palonosetron would be an option to lower the risk of the incidence of uncontrolled CINV.