Lahey Clinic Medical Center, Burlington, MA, USA.
Support Care Cancer. 2011 Dec;19(12):2063-6. doi: 10.1007/s00520-011-1286-6.
This study sought to prospectively determine the frequency of delayed nausea and vomiting with irinotecan-based chemotherapy following day 1 prophylaxis with a 5-HT3 receptor antagonist and dexamethasone.
Patients with colorectal cancer aged ≥ 18 years with ECOG performance status ≤ 2 receiving irinotecan alone, combined with cetuximab or as part of a standard folinic acid, 5- fluorouracil, irinotecan (FOLFIRI) regimen for the first time were eligible. All patients received a 5-HT3 receptor antagonist and dexamethasone 8 mg on day 1 prior to irinotecan. No routine prophylaxis for delayed emesis was given. Antiemetic outcome was recorded in patient-completed diaries for the 120-h study period after irinotecan administration. Primary endpoint was frequency of delayed (24-120 h) emesis.
Forty-four patients were enrolled, and all are evaluable. The median age was 61 (39-79) years; the male-female ratio was 37:7. Four patients (9%) experienced vomiting or retching during the delayed period. Three patients (7%) vomited during the first 24 h after irinotecan. The overall no emesis rate was 89% (39/44). Fifteen patients (34%) experienced delayed nausea (mildin 11 patients, moderate in four patients). Six patients (14%) took rescue antiemetics during the delayed period. Delayed and overall complete response (no emesis or use of rescue antiemetics) rates were 82% and 77% respectively.
The use of a 5-HT3 antagonist and dexamethasone prior to irinotecan results in excellent control of nausea and vomiting (CR 86%) during the 24 h after chemotherapy. Without further antiemetic treatment, most patients (82%) will not experience delayed emesis or require rescue antiemetics. Routine prophylaxis for delayed emesis following irinotecan does not appear to be warranted.
本研究旨在前瞻性地确定在伊立替康治疗的第 1 天采用 5-HT3 受体拮抗剂和地塞米松进行预防后，伊立替康为基础的化疗出现迟发性恶心和呕吐的频率。
符合条件的患者为年龄≥18 岁，ECOG 表现状态≤2 分，首次接受伊立替康单药治疗、联合西妥昔单抗治疗或作为标准的亚叶酸钙、5-氟尿嘧啶、伊立替康（FOLFIRI）方案的一部分。所有患者在伊立替康前第 1 天接受 5-HT3 受体拮抗剂和地塞米松 8mg。未给予常规预防迟发性呕吐。在伊立替康给药后 120 小时的研究期间，患者通过填写日记卡记录止吐治疗结果。主要终点是迟发性（24-120 小时）呕吐的频率。
共纳入 44 例患者，均为可评估患者。中位年龄为 61（39-79）岁；男女比例为 37:7。4 例患者（9%）在迟发性期出现呕吐或干呕。3 例患者（7%）在伊立替康后 24 小时内呕吐。总体无呕吐率为 89%（39/44）。15 例患者（34%）出现迟发性恶心（11 例轻度，4 例中度）。6 例患者（14%）在迟发性期使用了抢救性止吐药。迟发性和总完全缓解（无呕吐或使用抢救性止吐药）率分别为 82%和 77%。
在伊立替康治疗前使用 5-HT3 拮抗剂和地塞米松可极好地控制化疗后 24 小时内的恶心和呕吐（CR 86%）。未经进一步止吐治疗，大多数患者（82%）不会出现迟发性呕吐或需要抢救性止吐药。伊立替康后无需常规预防迟发性呕吐。
