Granisetron on par with palonosetron in preventing emesis in NSCLC patients

Both granisetron and palonosetron are comparable in the prevention of acute and delayed emesis in patients with nonsmall cell lung cancer (NSCLC) receiving cisplatin based high emetogenic chemotherapy (HEC), a study has shown.

“We found no significant difference between palonosetron and granisetron in preventing acute and delayed emesis in triplet antiemetic prophylaxis of patients receiving cisplatin-based HEC for NSCLC,” the researchers said.

A total of 121 patients with NSCLC who received triplet antiemetic prophylaxis treatment with aprepitant and dexamethasone plus granisetron or palonosetron before the first cycle of chemotherapy were enrolled in this prospective, multicentre, nonrandomized study conducted between June 2018 and December 2021. Of the participants, 61 received granisetron and 60 received palonosetron.

The research team applied the emesis scale to the patients during the outpatient control at the end of the first week after chemotherapy. Complete response (CR) and total control (TC) were the primary endpoints of the study.

CR was higher in the granisetron group during the acute phase (70.5 percent vs 58.3 percent; p=0.16) and higher in the palonosetron group during the delayed phase (61.7 percent vs 55.7 percent; p=0.5), albeit not statistically significant. [J Oncol Pharm Pract 2025;doi:10.1177/10781552241279537]

No significant difference was also noted in TC rates between the two treatment groups (54.1 percent vs 57.6 percent; p=0.69).

Antiemetic

A recent meta-analysis comparing the efficacy of the study drugs in both dual and triplet antiemetic combinations in patients receiving moderate emetogenic chemotherapy and HEC revealed equal efficacy in preventing acute chemotherapy-induced nausea and vomiting, while response rates were slightly higher with palonosetron in the delayed phase. [Eur J Clin Pharmacol 2021;77:1597-1609]

“Our findings were consistent with those of the meta-analysis, and we have stated that similar to the meta-analysis, there is no difference between palonosetron and granisetron in the triple combination in the prevention of acute and delayed emesis,” the researchers said.

“In the TRIPLE study, unlike our study and others, the control of delayed emesis was found to be significant in favour of palonosetron for the first time,” they added. [Ann Oncol 2016;27:1601-1606]

Setrons

In four prospective studies conducted on breast cancer patients, no statistical difference was observed between first- and second-generation setrons in acute and delayed emesis control. [Support Care Cancer 2013;21:2845-2851; Oncol Lett 2015;9:119-124; http://simul-europe.com/2016/mascc/posters]

“In these studies, only one type of HEC regimen (anthracycline and cyclophosphamide-based chemo) was used,” the researchers said.

In the pilot study, palonosetron was compared with ondansetron and in three other studies with granisetron. Palonosetron was administered at a dose of 0.75 and 0.25 mg in these studies. [Support Care Cancer 2013;21:2845-2851; Oncol Lett 2015;9:119-124; http://simul-europe.com/2016/mascc/posters; https://doi.org/10.1007/s00280-019-03831-4]

“NCCN and MASCC's current guidelines recommend using 5-HT3RA plus dexamethasone plus an NK-1 inhibitor and an olanzapine antiemetics combination in patients receiving HEC, and they stated that there is no difference between 5-HT3RAs,” the researchers said.

“For this reason, physicians can easily prefer the cheaper setron, which is more cost-effective, depending on the conditions of the country they live in,” they added.