Palonosetron, second generation 5-HT3 antagonist: a new perspective in CINV management

It is well established that the majority of cancer patients who undergo moderately or highly emetogenic cytotoxic treatment without receiving prophylactic antiemetics will experience chemotherapy-induced nausea and vomiting (CINV). Although the exact mechanisms of CINV are not fully known, it is clear from preclinical experiments and more than 15 years of clinical investigations that serotonin plays a major role in initiating nausea and vomiting associated with emetogenic chemotherapy. Emetogenic chemotherapy damages the gastrointestinal mucosa, causing the release of serotonin (5-hydroxytryptamine [5-HT]) from enterochromaffin cells in the small intestine, which, in turn, activates 5-HT3 receptors located on vagal afferents.