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Clinical evaluation of two antiemetic combinations palonosetron dexamethasone versus ondansetron dexamethasone in chemotherapy of head and neck cancer.

Author(s): Kaushal J, Gupta MC, Kaushal V, Bhutani G, Dhankar R, Atri R, Verma S

Affiliation(s): Department of Pharmacology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Haryana, India. kaushaljyoti@yahoo.co.in

Publication date & source: 2010-11, Singapore Med J., 51(11):871-5.

Publication type: Randomized Controlled Trial

INTRODUCTION: Palonosetron and ondansetron are two selective 5-hydroxytryptamine (5-HT3) receptor antagonists that have shown remarkable efficacy in controlling nausea and vomiting following administration of moderately emetic anticancer chemotherapy. Their efficacy is enhanced by the concurrent administration of dexamethasone. In the present study, we aimed to compare the antiemetic efficacy of a palonosetron plus dexamethasone (PD) schedule versus an ondansetron plus dexamethasone (OD) schedule. METHODS: A randomised, crossover trial was conducted in 30 patients with head and neck cancer who were receiving moderately emetogenic chemotherapy. The patients were divided into two groups. In the first cycle, one group was given a PD schedule and the other, an OD schedule. For the subsequent cycle, crossover of the antiemetic schedules was done. The antiemetic effects were evaluated by recording the intensity of nausea and the frequency of vomiting in the acute and delayed phases. RESULTS: Complete response in the acute phase was observed in 83.3 percent of the patients on the PD schedule and in 80 percent of those on the OD schedule. In the delayed phase, complete response was observed in 76.7 percent and 66.7 percent of the patients on the PD schedule and OD schedule, respectively. The overall rate of complete response was 66.7 percent in the PD group and 46.7 percent in the OD group. In the PD group, there were 73.3 percent of nausea-free patients as opposed to 66.7 percent in the OD group. CONCLUSION: The results suggest that the PD schedule was superior to the OD schedule in controlling emesis in cancer chemotherapy, although this difference was not statistically significant.

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