Palonosetron is a noninferior prophylactic and more cost-effective option for chemotherapy-induced vomiting (CIV) in pediatric patients with cancer receiving moderate to high emetogenic chemotherapy compared with ondansetron, according to a study published in Supportive Care in Cancer.

Ondansetron is a mainstay of CIV management but has a short half-life, leading to inconveniences in administration. Previous studies have compared the efficacy of ondansetron to palonosetron in preventing CIV, but requires further investigation.

For this prospective study, researchers randomly assigned 116 pediatric patients with cancer receiving moderate or high emetogenic chemotherapy to receive dexamethasone and IV palonosetron on day 1 of treatment or IV ondansetron 2 or 3 times daily. Patients receiving highly emetogenic therapy additionally received fosaprepitant. Treatment was initiated on day 1 of the first cycle on the study, and ondansetron was continued for 24 hours after the last dose of chemotherapy.

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Of the enrolled patients, 108 children were evaluable at the time of analysis. Results showed that 72.2% vs 83.3% of patients receiving ondansetron and palonosetron, respectively, had a complete response in the acute phase, confirming the noninferiority of palonosetron to ondansetron.

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Further analysis revealed that the only statistically significant risk factor predicting breakthrough emesis was the absence of dexamethasone in treatment. Furthermore, the cost of palonosetron administration is significantly lower than ondansetron.

The authors concluded that “a single dose of palonosetron is safe and noninferior to ondansetron for prevention of acute CIV in children and is also cost-effective. For patients where dexamethasone cannot be used in the prophylactic regimen, alternative strategies need to be explored.”


Jain S, Kapoor G, Koneru S, Vishwakarma G. A randomised, 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 [published online March 22, 2018]. Support Care Cancer. doi: 10.1007/s00520-018-4158-5