[The clinical development of an antiemetic in oncology. A meta-analysis]

To perform meta-analysis (MT) on antiemetic efficacy of LAS 30451 (Pancopride) in high and moderately emetogenic chemotherapy (CT).

The results of 13 phase II and III clinical trials comparing the efficacy of different doses of the drug under study with or without corticoids, or versus standard treatment (methochlopramide and/or corticosteroids and diphenhydramine) were included. The principal variable was complete protection in the acute phase (0 vomiting following 24 h post treatment).

The design was open in 3, simple blind in 4 and double blind in 6, with 11 being parallel and 2 crossed. The trials were carried out in 39 centers of 5 countries with 999 patients who received 1,292 cycles of antiemetic treatment. On comparison of lower or equal doses at 0.2 mg/kg of pancopride vs higher doses global OR was 0.94 (p = 0.72) with a global percentage difference (GPD) of -4.69% (p = 0.23) and GPD equal to -6.90. On treatment without cysplatin global OFR was equal to 1.10 (p = 0.69) with GPD of -8.99% favoring dosage lower than or equal to 0.2 mg/kg. The dexamethasone increased antiemetic efficacy of pancopride in both treatments with cysplatin (50% vs 76%, p = 0.08) and without cysplatin (50% to 89%, p = 0.02). When pancopride was compared with that of standard antiemetic treatment (methochlopramide and/or corticosteroids) global OR was equal to 0.69 (p = 0.07) with GPD of -6.84% favoring the control treatment. In CT containing cysplatin, global OR was equal to 0.73 (p = 0.38) with GPD of -3.28% and with CT without cysplatin the global OR was 0.66. (p = 0.12) with a GPD of -4.92% in both cases favoring the control treatment.

No statistically significant differences were observed with regard to the antiemetic efficacy of pancopride on comparison of different doses of the drug. The antiemetic efficacy of pancopride increases when given together with dexamethasone. The efficacy of pancopride is lower to that of methochlopramide in combination with corticosteroids and/or diphenhydramine although the differences are not statistically significant.