Efficacy of thalidomide, neurokinin-1 receptor antagonist, and olanzapine in combination with palonosetron plus dexamethasone in preventing chemotherapy-induced nausea and vomiting (CINV) induced by highly emetogenic chemotherapy (HEC): Bayesian network meta-analysis.

e14514Background: The combination of palonosetron and dexamethasone in the prevention of CINV has been the standard of care. Using a third agent is indicated for HEC. Several trials have examined adding thalidomide, neurokinin-1 receptor antagonist, and olanzapine to this combination regimen. In the absence of head-to-head trials, we conducted a Bayesian network meta-analysis to compare the efficacy of these additional agents in combination with palonosetron plus dexamethasone in preventing CINV induced by HEC. Methods: We identified 8 eligible studies involving 2859 patients through a search of PubMed/Medline and Embase databases. We conducted a Bayesian network meta-analysis using fixed and random effect models for Complete Response (CR) and Rate of No Nausea (RNN) in the acute, delayed, and overall phases. Results: Olanzapine-based regimens showed significantly greater CR than thalidomide-based (OR 3.59, 95% Cr.I 1.34-10.67) and NK-1-based regimens in the acute phase (OR 2.77, 95% Cr.I 1.31- 6.06), as ...