Cancer Council Australia, Sydney 2000, Australia.
Support Care Cancer. 2011 Mar;19 Suppl 1:S49-55. doi: 10.1007/s00520-010-1036-1. Epub 2010 Nov 10.
As a part of reviewing the Multinational Association of Supportive Care in Cancer (MASCC) antiemetic guidelines in Perugia in 2009, an expert group identified directions for future antiemetic research.
In future trials, the prediction of nausea and vomiting may combine algorithms based on observed prognostic factors relating to the patient and the anticancer therapy, the identification of the genes that code for receptors, and pharmacogenetic studies of the metabolism of drugs. Design issues for future trials include standardising the emetic stimulus across studies and finding the minimum tolerated effective dose and schedule of an antiemetic. Also control of delayed emesis is not independent of the control of acute emesis. The full range of side effects and the impact on global quality of life scores should be part of the routine assessment of an antiemetic. With current high rates of control of acute vomiting, future trials will need to consider new primary endpoints such as nausea, a complex symptom, where improvement is needed. Economic endpoints should be incorporated to ascertain the cost benefit of antiemetic prophylaxis, taking into account the impact of nausea on work capacity. New antiemetic drugs may be targeted at different receptors, such as opioid, cannabinoid and peptide YY receptors. New research is needed into determining the extent of corticosteroid use. The emetic potential of a range of newer cytotoxics particularly when used in combinations and different scheduling, such as prolonged oral dosing of cytotoxics and use of targeted therapies, are all areas in need of research. More antiemetic studies are needed in niche areas such as in patients receiving high dose chemotherapy, radiation therapy or combined modality therapy. Further evidence of the efficacy of newer antiemetic agents is required in children.
作为 2009 年在佩鲁贾对多国支持性护理癌症协会（MASCC）止吐指南进行审查的一部分，专家组确定了未来止吐研究的方向。
在未来的试验中，恶心和呕吐的预测可能会结合基于与患者和抗癌治疗相关的观察到的预后因素的算法、识别编码受体的基因，以及药物代谢的药物遗传学研究。未来试验的设计问题包括在研究中使呕吐刺激标准化，并找到最低耐受有效剂量和止吐药的方案。另外，迟发性呕吐的控制与急性呕吐的控制并不独立。止吐药的全面副作用和对全球生活质量评分的影响应成为常规评估的一部分。由于目前急性呕吐的控制率很高，未来的试验将需要考虑新的主要终点，如需要改善的复杂症状恶心。应纳入经济终点，以确定止吐预防的成本效益，同时考虑到恶心对工作能力的影响。新的止吐药物可能针对不同的受体，如阿片类受体、大麻素受体和肽 YY 受体。需要新的研究来确定皮质类固醇使用的程度。一系列新型细胞毒素的致吐潜力，特别是当它们联合使用和不同方案使用时，如延长口服细胞毒素给药和使用靶向治疗，都是需要研究的领域。在接受高剂量化疗、放射治疗或联合治疗的患者等利基领域需要进行更多的止吐研究。需要在儿童中进一步证明新型止吐药物的疗效。
