Hamadani Mehdi, Chaudhary Lubna, Awan Farrukh T, Khan Jawad K, Kojouri Kiarash, Ozer Howard, Tfayli Arafat
Arthur G. James Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43228, US.
J Oncol Pharm Pract. 2007 Jun;13(2):69-75. doi: 10.1177/1078155207078137.
The last decade has witnessed the great impact of 5-hydroxytryptamine-3 receptor (5-HT(3))antagonists in revolutionizing the management of platinum-based chemotherapy-induced acute nausea and vomiting (CINV). However, despite the availability of a variety of 5-HT(3) antagonists, little data is published to support superiority of one drug over another, leaving the choice of serotonin receptor antagonist largely empirical. The National Comprehensive Cancer Network and American Society of Clinical Oncology guidelines for management of chemotherapy-associated nausea and vomiting cleary endorse the use of serotonin receptor antagonist; however, no single agent is preferred over the rest.
Data for patients (n=159) receiving platinum-based chemotherapy regimens were retrospectively collected . Patients getting 5-HT(3) antagonists without steriods or those with known history of brain metastasis, gastroparesis, and intestinal obstruction were not eligible for the study. Patient characteristics including age, gender, primary diagnosis, history of heavy alcohol intake, chemotherapy regimen administered , number of cycles, and Eastern Cooperative Group performance status at the start of therapy were noted. Primary outcome was the complete control of platinum-induced acute nausea and vomiting. Secondary outcome measures included control of > or = grade 1 nausea or vomiting, comparison of two doses of dexamethasone, and antiemetic eficacy among various platinum drugs. National Cancer Institute Common Toxicity Criteria version 2.0 was used to assess toxicity.
A total of 126 patients received 369 cycles of platinum-based therapy. Dolasetron ( n=157), granisetron ( n=81), and ondansetron ( n=131) achieved complete control of vomiting in 89.8, 95.5, and 92.3% (p=0.67) of cycles, respectively. Respectively, complete nausea control was observed in 68.1, 75.3 and, 69.4% (p=0.50). Dexamethasone 20 mg was not superior to 10 mg in complete control of nausea and vomiting ( p= 0.15 and p=0.63, respectively). However, complete nausea control was signinficantly better in the subgroup of patients getting cisplatin-compared with carboplatin-based regimens (78.8% vs. 67.7%, p<0.05).
No significant difference exists in the antiemetic efficacy of the three 5-HT(3) antagonists studied in controlling CINV when administered in combination with dexamethasone. Choicce of antiemetic regimen should therefore be based on drug cost.
过去十年见证了5-羟色胺-3受体（5-HT(3)）拮抗剂在彻底改变铂类化疗所致急性恶心和呕吐（CINV）管理方面的巨大影响。然而，尽管有多种5-HT(3)拮抗剂可供使用，但很少有数据表明一种药物优于另一种药物，这使得血清素受体拮抗剂的选择很大程度上是经验性的。美国国立综合癌症网络和美国临床肿瘤学会关于化疗相关性恶心和呕吐管理的指南明确支持使用血清素受体拮抗剂；然而，没有一种药物比其他药物更受青睐。
回顾性收集接受铂类化疗方案的患者（n = 159）的数据。接受不含类固醇的5-HT(3)拮抗剂或有脑转移、胃轻瘫和肠梗阻病史的患者不符合本研究条件。记录患者特征，包括年龄、性别、原发性诊断、大量饮酒史、所给予的化疗方案、周期数以及治疗开始时的东部肿瘤协作组体能状态。主要结局是完全控制铂类所致急性恶心和呕吐。次要结局指标包括控制≥1级恶心或呕吐、比较两剂地塞米松以及各种铂类药物的止吐疗效。采用美国国立癌症研究所通用毒性标准第2.0版评估毒性。
共有126例患者接受了369个周期的铂类治疗。多潘立酮（n = 157）、格拉司琼（n = 81）和昂丹司琼（n = 131）分别在89.8%、95.5%和92.3%（p = 0.67）的周期中实现了呕吐的完全控制。恶心完全控制率分别为68.1%、75.3%和69.4%（p = 0.50）。20 mg地塞米松在完全控制恶心和呕吐方面并不优于10 mg地塞米松（分别为p = 0.15和p = 0.63）。然而，与基于卡铂的方案相比，接受顺铂的患者亚组中恶心完全控制情况明显更好（78.8%对67.7%，p < 0.05）。
在与地塞米松联合使用时，所研究的三种5-HT(3)拮抗剂在控制CINV的止吐疗效方面不存在显著差异。因此，止吐方案的选择应基于药物成本。
