• are afraid that if they ‘complain’
their chemotherapy dose will be
reduced, delayed or stopped
• do not want to seem weak
• might have forgotten the
severity by the time of their next
assessment if symptoms develop
after they have returned home.
With the correct use of
antiemetic drugs, CINV can be
prevented in almost 70%, and
even up to 80%, of patients.
However, despite the availability
of guidelines, there is emerging
evidence that adherence to, and
implementation of, treatment
recommendations are less than
optimal. 18 Only 11% of HEC,
29% of AC and 39% of MEC
patients receive an antiemetic
prophylaxis consistent
with international
antiemetic
guidelines. 19
Adherence
to treatment
guidelines
can improve
outcomes. In
a prospective
observational
study of almost 1000
chemotherapy-naïve
patients receiving single-
day HEC or MEC, 59.9% (172/287)
of patients in the guideline
consistent CINV prophylaxis group
achieved a complete response (CR)
compared with 50.7% (357/704) in
the guideline-inconsistent CINV
prophylaxis group (p=0.008). 1
Adherence to a single dose of
NEPA and efficacy of NEPA was
shown in those 1286 (88%) patients
who participated in a Phase III trial
with a multiple-cycle extension for
a total of 5969 cycles. Out of these
patients 76% completed ≥4 cycles.
The proportion of patients with an
overall CR was significantly greater
for NEPA than oral palonosetron
for cycles 1–4 (74.3 vs 66.6%, 80.3
vs 66.7%, 83.8 vs 70.3%, and 83.8 vs
74.6%, respectively; p≤0.001 each
cycle). The cumulative percentage
of patients with a sustained CR
over all four cycles was also greater
for NEPA (p<0.0001). 19
Choice and convenience
Patient choice and patient
preference might
influence adherence to
antiemesis regimens.
For example, being
offered an oral
rather than an IV
formulation may
be attractive for
some patients,
particularly in the
outpatient setting.
The efficacy
of IV palonosetron
in controlling CINV in
patients with cancer receiving
treatment with a variety of
chemotherapy regimens has been
demonstrated. 20–23
In a randomised, controlled
study of 738 chemotherapy-naïve
adult patients with solid tumours
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