Herrstedt Jørn, Koeller Jim M, Roila Fausto, Hesketh Paul J, Warr David, Rittenberg Cynthia, Dicato Mario
Department of Oncology 54 B1, Copenhagen University Hospital, DK-2730 Herlev, Denmark.
Support Care Cancer. 2005 Feb;13(2):97-103. doi: 10.1007/s00520-004-0701-7. Epub 2004 Nov 23.
This paper is a review of the recommendations for the prophylaxis of acute emesis induced by moderately emetogenic chemotherapy as concluded at the Perugia Consensus Conference, which took place at the end of March 2004. The review focuses on new studies appearing since the last consensus conference in 1997. The following issues are addressed: dose and schedule of antiemetics, different groups of antiemetics such as corticosteroids, serotonin (5-HT(3))-receptor antagonists, dopamine D(2) receptor antagonists, and neurokinin (NK(1)) receptor antagonists. Antiemetic prophylaxis in patients receiving multiple cycles of moderately emetogenic chemotherapy is also reviewed. Consensus statements are given, including optimal dose and schedule of 5-HT(3)-receptor antagonists and of dexamethasone. The new 5-HT(3)-receptor antagonist, palonosetron, is a reasonable alternative to the well-established agents of this class--ondansetron, granisetron, tropisetron and dolasetron. It is concluded that the best prophylaxis in patients receiving moderately emetogenic chemotherapy is still the combination of one of the 5-HT(3)-receptor antagonists and dexamethasone. The results of studies adding a NK(1)-receptor antagonist to this combination are awaited and might change future recommendations.
本文是对2004年3月底在佩鲁贾共识会议上得出的关于中度致吐性化疗所致急性呕吐预防建议的综述。该综述聚焦于自1997年上次共识会议以来出现的新研究。探讨了以下问题：止吐药的剂量和给药方案、不同类别的止吐药，如皮质类固醇、5-羟色胺（5-HT(3)）受体拮抗剂、多巴胺D(2)受体拮抗剂和神经激肽（NK(1)）受体拮抗剂。还对接受多个周期中度致吐性化疗患者的止吐预防进行了综述。给出了共识声明，包括5-HT(3)受体拮抗剂和地塞米松的最佳剂量和给药方案。新型5-HT(3)受体拮抗剂帕洛诺司琼是该类成熟药物——昂丹司琼、格拉司琼、托烷司琼和多拉司琼的合理替代药物。得出的结论是，接受中度致吐性化疗患者的最佳预防方案仍是5-HT(3)受体拮抗剂之一与地塞米松的联合使用。在该联合方案中加用NK(1)受体拮抗剂的研究结果有待观察，可能会改变未来的建议。
