A randomized, open-label non-inferiority study to compare palonosetron and ondansetron for prevention of acute chemotherapy-induced vomiting in children with cancer receiving moderate or high emetogenic chemotherapy

Abstract

Palonosetron is non-inferior and cost-effective compared to ondansetron for prevention of acute chemotherapy-induced vomiting (CIV) in children receiving moderate and high emetogenic chemotherapy.

Dexamethasone dosing for prevention of acute chemotherapy‐induced vomiting in pediatric patients: A systematic review

“…Of these, 16 studies (29 single-study arms) met our inclusion criteria ( Figure 1). 7,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Agreement between reviewers for inclusion of studies was almost perfect (kappa = 0.87; 95% CI: 0.75-0.98).…”

“…The evidence base that met the eligibility criteria consisted of 29 single-study arms, 25 of which were from 13 randomized trials. 7,[22][23][24][25][26][27][28][29][30][31][32][33] The other four single-study arms were from two noncomparative prospective studies 34,35 (N = 2) and one noncomparative retrospective study 36 (N = 2). Similar to how study arms from comparative studies were counted, complete acute CIV control was able to be determined for patients receiving HEC and MEC separately for the retrospective study and thus it was treated as having two study arms.…”

“…The sample sizes of the majority of included study arms were small: only six included ≥100 patients. 23,31,36 Of the 29 study arms included, 13 evaluated complete acute CIV control in patients exclusively receiving HEC, [22][23][24][25][26]35,36 eight in patients exclusively receiving MEC [25][26][27][28]30,36 and eight in patients receiving MEC or HEC that reported their findings as a single group and who for the purposes of this review were categorized as MEC. 7,29,[31][32][33][34] There was high heterogeneity in the study populations, cointerventions and outcomes between the dexamethasone dosing regimens evaluated, even when dichotomized based on the scaled recommended adult dexamethasone doses.…”

“…In addition, only 79% of study arms (23/29) measured acute CIV or CINV control using acceptable methods (i.e., clinician assessment, patient diaries, and validated nausea assessment tools where CINV was reported). 7,22,23,[25][26][27][28][29]31,[33][34][35] Consequently, meta-analysis was not possible, and the results are narratively described.…”

“…HEC : Of the 13 included study arms with patients receiving HEC, 12 evaluated a CPG-consistent antiemetic regimen. [22][23][24][25][26]35,36 The most common regimen used was dexamethasone in combination with a 5HT 3 antagonist alone (8 study arms), [22][23][24][25]35,36 followed by four study arms that evaluated dexamethasone in combination with a 5HT 3 antagonist plus aprepitant or fosaprepitant. 22,25,26 Only one study arm evaluated dexamethasone in a non-CPG-consistent regimen.…”