Chemotherapy-Induced Nausea and Vomiting (CINV) Management with Palonosetron

Dosing and Efficacy

Palonosetron is only available as an intravenous formulation for CINV, administered as a single 0.25 mg IV dose over 30 seconds, approximately 30 minutes before chemotherapy initiation, as recommended by the European Society for Medical Oncology 1, 2, 3
No schedule has been proven better than a single dose beginning before chemotherapy, with a strength of evidence level of high, according to the American Society of Clinical Oncology 4
A meta-analysis of eight trials concluded there is no difference in efficacy between the 0.25 mg and 0.75 mg doses of palonosetron, with a moderate strength of evidence, as reported by the National Comprehensive Cancer Network 4

For highly emetogenic chemotherapy, a three-drug regimen is recommended including palonosetron 0.25 mg IV, dexamethasone, and aprepitant, with a high strength of evidence, as suggested by the Multinational Association of Supportive Care in Cancer 4, 5
For moderately emetogenic chemotherapy, palonosetron can be used alone or in combination with dexamethasone, with a moderate strength of evidence, according to the European Society for Medical Oncology 4, 5