Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Gueishan Township, Taoyuan County, Taiwan.
Support Care Cancer. 2012 Oct;20(10):2357-61. doi: 10.1007/s00520-011-1345-z. Epub 2011 Dec 21.
Chemotherapy-induced emesis remains a problem despite prophylaxis with 5-hydroxytryptamine (5-HT3) antagonists and dexamethasone. The purpose of the current study was to evaluate the efficacy of adding aprepitant, a neurokinin-1(NK-1) receptor antagonist, as a secondary antiemetic prophylaxis in cases failing to achieve full protection against emesis during the first cycle of a cisplatin-based regimen.
Patients receiving chemotherapy with a dose of at least 50 mg/m(2) of cisplatin-based regimens were eligible. If patients failed to achieve complete protection against vomiting when antiemetics (5-HT3 antagonists and dexamethasone) were given in cycle 1, aprepitant was added in subsequent cycles. The primary endpoint was complete response (no emetic episodes and no rescue antiemetics) during days 1-6.
We analyzed 257 patients consecutively. Forty-nine patients (19%) had acute and/or delayed emesis during the first cycle of chemotherapy. Forty of 49 patients received aprepitant for secondary prophylaxis of emesis in the second cycle. Complete protection from vomiting and nausea was achieved in 63% and 55% of patients, respectively. Thirty-five patients received aprepitant for the third cycle. Complete protection from vomiting and nausea was achieved in 77% and 71% of patients, respectively.
Primary antiemetic prophylaxis with 5-HT3 antagonists plus dexamethasone provided more than 80% complete protection against cisplatin-induced emesis. Addition of aprepitant as secondary antiemetic prophylaxis in subsequent cycles provided adequate emesis protection in patients who failed primary prophylaxis. Using aprepitant as secondary antiemetic prophylaxis for cancer patients with cisplatin-induced emesis is feasible and cost-effective.
尽管使用 5-羟色胺（5-HT3）拮抗剂和地塞米松进行了预防，但化疗引起的呕吐仍然是一个问题。本研究的目的是评估添加阿瑞匹坦（一种神经激肽-1（NK-1）受体拮抗剂）作为二线止吐预防药物的疗效，适用于在顺铂为基础的方案的第一个周期中未能完全预防呕吐的患者。
符合条件的患者接受至少 50mg/m²顺铂为基础的方案化疗。如果患者在第一个周期中使用止吐药（5-HT3 拮抗剂和地塞米松）未能完全预防呕吐，在随后的周期中添加阿瑞匹坦。主要终点是第 1-6 天的完全缓解（无呕吐发作和无解救性止吐药）。
我们分析了 257 例连续患者。49 例（19%）在第一个化疗周期中出现急性和/或迟发性呕吐。49 例中有 40 例在第二个周期中接受阿瑞匹坦进行二线止吐预防。分别有 63%和 55%的患者完全预防呕吐和恶心。35 例患者接受阿瑞匹坦进行第三个周期。分别有 77%和 71%的患者完全预防呕吐和恶心。
5-HT3 拮抗剂加地塞米松的一线止吐预防提供了超过 80%的顺铂引起的呕吐完全缓解。在随后的周期中添加阿瑞匹坦作为二线止吐预防药物可在一线预防失败的患者中提供充分的止吐保护。在顺铂引起呕吐的癌症患者中使用阿瑞匹坦作为二线止吐预防是可行且具有成本效益的。
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