Efficacy and safety of thalidomide for chemotherapy-induced nausea and vomiting

Purpose: A substantial number of cancer patients discontinue chemotherapy due to severe chemotherapy-induced nausea and vomiting (CINV). This study aimed to evaluate the efficacy and safety of thalidomide (THD) in CINV. Methods: We searched different databases to identify related studies that investigated the efficacy and safety of THD in CINV. The primary outcomes were CINV in the acute (0-24 h), delayed (24-120 h), and overall (0-120 h) phases, respectively. The secondary outcomes were the safety of THD and the patients' quality of life (QOL). Results: Fourteen randomized control trials (RCTs) including 1744 patients (42% male) reported the risk ratio (RR) and 95%CI of the THD group versus control group in reducing nausea and vomiting. Meta-analysis showed that THD statistically enhanced the complete response rate of nausea and vomiting in the delayed (nausea: RR = 1.69, 95%CI: 1.47-1.94; vomiting: RR = 1.38, 95%CI: 1.26-1.51) and overall phases (nausea: RR = 1.54, 95%CI: 1.31-1.81; vomiting: RR = 1.31, 95%CI: 1.18-1.46). Furthermore, subgroup analysis based on THD dosage (100 vs 200 mg/day) demonstrated no statistical significance with respect to overlapping 95%CI. Thirty studies monitored the adverse events (AEs) of THD, all under grade 3 based on the CTCAE criteria. We compared the eight most common AEs; sedation, constipation, and drowsiness/dizziness were slightly frequent compared with controls. Conclusion: THD is an effective adjuvant and a potential alternative in reducing delayed and overall CINV. Other regimens might be added for CINV during the acute phase.