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Granisetron patch prevents CINV for patients with hematologic malignancies
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Granisetron transdermal system patch prevented chemotherapy-induced nausea and vomiting as well as oral granisetron in patients with hematologic malignancies, according to results of a post-hoc analysis presented at the Oncology Nursing Society Annual Congress.
“Despite prophylaxis, chemotherapy-induced nausea and vomiting (CINV), especially during the delayed phase, remains a barrier to attaining planned chemotherapy dose on time for some patients,” Karen A. Pekle, ANP, BS, BSN, MS, nurse practitioner at NewYork-Presbyterian and Weill Cornell Medicine, and colleagues wrote. “A granisetron transdermal system has been shown to be as effective as oral granisetron in controlling CINV across multiple tumor types."
Pekle and colleagues conducted a retrospective analysis of a phase 3 study that determined the efficacy and safety of granisetron transdermal system (Sancuso, Kyowa Kirin) for patients with cancer.
In the study, patients treated with moderately or highly emetogenic chemotherapy received granisetron transdermal system patch (7-day application) or oral granisetron (2 mg daily).
Pekle and colleagues restricted their analysis to patients from the study with a primary diagnosis of lymphoma (n = 51), leukemia (n = 27) or multiple myeloma (n = 5).
Of these 83 patients, 52 received the granisetron transdermal system patch and 31 received oral granisetron.
Fifty-nine patients (71%) received a noncisplatin regimen with corticosteroids. Thirty-seven patients (45%) received chemotherapy for 3 days and 46 patients (45%) received chemotherapy for 4 or 5 days.
Researchers evaluated the occurrence of complete control — defined as no vomiting, mild nausea and use of no rescue medication — and complete response, or no vomiting or rescue medication, during the acute (first 24 hours) and delayed phases (days 2-5) after chemotherapy.
A similar proportion of patients who received the granisetron transdermal system patch vs. oral granisetron achieved complete control (94% vs. 94%) and complete response (94% vs. 95%) during the acute phase.
However, during the delayed phase, a greater proportion of patients in the granisetron transdermal system patch group achieved complete control (87% vs. 77%) and complete response (90% vs. 81%), but this difference did not reach statistical significance.
Granisetron transdermal system patch appeared well tolerated. One patient experienced mild constipation.
The researchers concluded that the data suggest granisetron transdermal system patch may be appropriate for the prevention of CINV in patients with hematologic malignancies. – by Nick Andrews
Reference:
Pekle K, et al. Presented at: Oncology Nursing Society Annual Congress; April 28-May 1; San Antonio, Texas.
Disclo sure: The study was funded by Kyowa Kirin.
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David L. Jennings II, MSN, RN, AGPCNP-BC
The trial showed that the granisetron transdermal system patch (Sancuso, Kyowa Kirin) is superior in managing chemotherapy-induced nausea and vomiting (CINV) in patients with hematologic malignancies compared with oral granisetron in the delayed nausea/vomiting phase. In the acute phase, the efficacy of oral and transdermal granisetron was shown to be comparable.
The granisetron patch would be especially useful in patients with dysphagia, mucositis and inadequate gastrointestinal absorption. There are risks associated with using the patch, including QTc prolongation and sensitivity to sunlight, among others. In the trial, mild constipation was the only adverse event thought to be related to granisetron.
At my institutions pharmacy, the cash price for four granisetron patches is over $2,000.00. Although this might seem prohibitive, it is typically approved by insurance if prior authorization is obtained and when documentation is provided of failure of two oral antiemetics. Additionally, Kyowa Kirin (previously ProStrakan), which produces the patch, has an extensive patient assistance program.
In my practice setting, oral granisetron is rarely prescribed in both solid tumor oncology and hematologic malignancies. The tumor types involved in this trial were hematologic (lymphoma, leukemia and multiple myeloma). I work primarily with solid tumor types (lung, head and neck, and brain), and although we prescribe the granisetron patch in cases where standard emetogenic regimens fail which occurs somewhat infrequently I would be interested in research aimed at the patchs efficacy in solid tumor oncology compared with in hematologic malignancies.
Seventy-one percent of patients in the trial received chemotherapy regimens that did not include cisplatin. Cisplatin regimens are frequently prescribed in the patient population who I serve, so further research examining the patchs efficacy in patients receiving cisplatin would be of particular interest.
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