Palonosetron in the prevention of chemotherapy-induced nausea and vomiting in Italy: pharmacoeconomic and clinical aspects

Abstract

Despite considerable improvements in the last two decades, chemotherapy-induced nausea and vomiting (CINV) remains a frequent and very bothersome medical problem. It is estimated that about one half to two thirds of all chemotherapy-treated patients experience CINV, the frequency depending on the chemotherapy regimen used and on patient-specific features. The impact of CINV, which may be acute, delayed or even anticipatory in experienced patients, on health-related quality of life (HRQoL) is substantial in all domains. 
Until recently, effective treatment choices included corticosteroids and first-generation 5-HT3 antagonists, which have been supported by aprepitant, the first clinically available NK1 antagonist, and by palonosetron, considered the first second-generation 5-HT3 antagonist for its high receptor-subtype selectivity and affinity and long plasmatic half-life. In this paper, clinical pharmacology of the latter drug is briefly outlined and recent Italian papers on the epidemiology and HRQoL impact of CINV are reviewed, as well as national pharmacoeconomic evalutations conducted on palonosetron. The role in therapy of palonosteron and its potential for improved clinical, HRQoL and economic outcomes is discussed.