title: Palonosetron versus granisetron in combination with aprepitant for the prevention of chemotherapy-induced nausea and vomiting in patients with gynecologic cancer.
abstract: OBJECTIVE
  There is no research regarding the appropriate antiemetic agents for female patients, especially those receiving moderately emetogenic chemotherapy (MEC). We evaluated the antiemetic efficacy of a combination of 5-HT₃ receptor with/without aprepitant in patients with gynecological cancer treated with the TC (paclitaxel and carboplatin) regimen of MEC.
  
  
  METHODS
  We enrolled 38 patients diagnosed with gynecologic cancer and scheduled to receive the TC regimen. The patients were randomly assigned to receive a 5-HT₃ receptor antagonist, either palonosetron in the first cycle followed by granisetron in the second cycle or vice versa. In the third cycle, all patients received a combination of the 5-HT₃ receptor and dexamethasone with/without aprepitant.
  
  
  RESULTS
  When three drugs were administered, palonosetron consistently produced an equivalent complete response (CR) rate to granisetron in the acute phase (89.5% vs. 86.8%, p=0.87) and delayed phase (60.5% vs. 65.8%, p=0.79). With regard to the change in dietary intake, palonosetron exhibited similar efficacy to granisetron in the acute phase (92.1% vs. 89.4%, p=0.19) and delayed phase (65.7% vs. 68.4%, p=0.14). However, in the delayed phase, the addition of aprepitant therapy with a 5-HT₃ receptor antagonist and dexamethasone produced a higher CR rate than a 5-HT₃ receptor antagonist with dexamethasone (93.3% vs. 47.8%, p<0.001) and allowed the patients to maintain a higher level of dietary intake (93.3% vs. 56.5%, p<0.001).
  
  
  CONCLUSIONS
  The addition of aprepitant therapy was more effective than the control therapy of a 5-HT₃ receptor antagonist, and dexamethasone in gynecological cancer patients treated with the TC regimen.
authors.affiliation: Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan.
authors.forename: Satoe
authors.initials: S
authors.lastname: Fujiwara
authors.affiliation: Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan. y-terai@poh.osaka-med.ac.jp.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Terai
authors.affiliation: Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tsunetoh
authors.affiliation: Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sasaki
authors.affiliation: Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Kanemura
authors.affiliation: Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan.
authors.forename: Masahide
authors.initials: M
authors.lastname: Ohmichi
mesh_terms: D000328:Adult; D000368:Aged; D000932:Antiemetics / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D000077608:Aprepitant; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D018592:Cross-Over Studies; D004032:Diet; D004334:Drug Administration Schedule; D005260:Female; D005833:Genital Neoplasms, Female / Q000188:drug therapy*; D017829:Granisetron / Q000008:administration & dosage; D006801:Humans; D007546:Isoquinolines / Q000008:administration & dosage; D008875:Middle Aged; D009025:Morpholines / Q000008:administration & dosage; D009325:Nausea / Q000139:chemically induced / Q000517:prevention & control*; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects; D000077924:Palonosetron; D011812:Quinuclidines / Q000008:administration & dosage; D058831:Serotonin 5-HT3 Receptor Antagonists; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control*
chemical_list: D000932:Antiemetics; D000077608:Aprepitant; D016190:Carboplatin; D017829:Granisetron; D007546:Isoquinolines; D009025:Morpholines; D017239:Paclitaxel; D000077924:Palonosetron; D011812:Quinuclidines; D058831:Serotonin 5-HT3 Receptor Antagonists
keywords: Antiemetics; Aprepitant; Granisetron; Neoplasms; Palonosetron; Serotonin 5-HT₃ Receptor Antagonist