Impact of a reduced palonosetron maximum dose on the incidence of
chemotherapy-induced nausea and vomiting in pediatric patients
Abstract
Background Palonosetron is a serotonin-3 (5-HT3) receptor antagonist
indicated in the prevention of chemotherapy-induced nausea and vomiting
(CINV) in pediatric and adult patients. Traditional dosing for
palonosetron in the pediatric population has been 20 mcg/kg with a
maximum dose of 1500 mcg. This study aimed to evaluate the impact of an
institutional dose cap of 750 mcg on pediatric CINV. Procedure This is a
retrospective chart review of admitted patients given palonosetron
intended for prevention of CINV at a pediatric medical center between
July 1, 2018 and June 30, 2020. Patients 1 month up to 17 years of age
who received at least one dose of palonosetron prior to chemotherapy
(not preceding stem cell transplant) were included. Information
regarding chemotherapy, antiemetic premedication, emesis, and
breakthrough antiemetic agents were recorded to quantify the instances
of CINV. Results Seven hundred and seventy-one patient encounters met
inclusion criteria (n=485 traditional dose, n=286 dose capped). There
was no statistical difference in the instances of emesis (p=0.98) or
breakthrough agents administered (p=0.65) between the two groups. Dose
capping patients at 750 mcg reduced cost by approximately 34.9%
compared to traditional dosing. Conclusions The use of a dose cap of
palonosetron at 750 mcg maintains efficacy for prevention of CINV while
reducing cost in pediatric patients receiving chemotherapy.