Ito Sumiyo, Tsukiyama Ikuto, Ando Masahiko, Katakami Masayo, Hamanaka Rie, Kosaka Kenshi, Matsubara Ayako, Nishimura Masaki, Tanaka Hiroyuki, Asai Nobuhiro, Yokoe Norihito, Takahashi Ayumu, Baba Kenji, Matsuura Katsuhiko, Yamaguchi Etsuro, Kubo Akihito
Department of Pharmacy, Aichi Medical University Hospital, Aichi, Japan.
Support Care Cancer. 2015 Apr;23(4):905-12. doi: 10.1007/s00520-014-2430-x. Epub 2014 Sep 17.
Neurokinin-1 (NK-1) receptor antagonist is recommended for chemotherapy-induced nausea and vomiting (CINV) in highly emetogenic chemotherapy (HEC) and has recently been introduced to oncology practice in Japan. However, whether all patients undergoing HEC truly need NK-1 receptor antagonist remains unknown, and increasing medical costs due to uniform use of NK-1 receptor antagonist are a concern. This study was conducted to examine the prevalence of patients who needed aprepitant at the time of its introduction in Japan, and therapeutic and preventive effects of aprepitant on HEC or moderately emetogenic chemotherapy (MEC).
Eligible patients with thoracic malignancies who were to undergo HEC or MEC received 5-hydroxytryptamine receptor antagonists and dexamethasone to prevent CINV. Aprepitant was administered to treat CINV occurring in the first course, or to prevent CINV in the second course. Frequency of vomiting, degree of nausea, and quality of life with respect to CINV were assessed.
In total, 96 patients were enrolled. Aprepitant was not administered in 57 and 88 % of patients who received HEC and MEC, respectively. In patients treated with aprepitant (n = 18), therapeutic use of aprepitant after occurrence of CINV (n = 9) decreased average scores in numerical rating scale for nausea from 7.44 to 5.44 (p = 0.10), and average frequency of vomiting per day from 2.11 to 0.11 (p = 0.03). Prophylactic use of aprepitant in the second course (n = 18) increased the proportion of patients with no significant nausea from 6 % (first course) to 50 % (second course; p = 0.007), and those with no vomiting from 33 to 89 % (p = 0.002). Aprepitant use also significantly improved quality of life with respect to CINV in the second course.
More than half of patients receiving HEC and 88 % of patients receiving MEC did not use aprepitant. Aprepitant showed significant therapeutic and preventive effects on CINV in patients who truly needed it.
神经激肽-1（NK-1）受体拮抗剂被推荐用于高度致吐性化疗（HEC）引起的化疗所致恶心和呕吐（CINV），且最近已引入日本肿瘤学实践中。然而，所有接受HEC的患者是否真的需要NK-1受体拮抗剂仍不清楚，因统一使用NK-1受体拮抗剂导致医疗成本增加令人担忧。本研究旨在调查在日本引入阿瑞匹坦时需要该药的患者比例，以及阿瑞匹坦对HEC或中度致吐性化疗（MEC）的治疗和预防效果。
符合条件的胸段恶性肿瘤患者接受HEC或MEC治疗，给予5-羟色胺受体拮抗剂和地塞米松以预防CINV。阿瑞匹坦用于治疗第一疗程出现的CINV，或预防第二疗程的CINV。评估呕吐频率、恶心程度以及CINV相关的生活质量。
总共纳入96例患者。接受HEC和MEC的患者中，分别有57%和88%未使用阿瑞匹坦。在使用阿瑞匹坦的患者（n = 18）中，CINV发生后使用阿瑞匹坦进行治疗（n = 9）使恶心数字评定量表的平均得分从7.44降至5.44（p = 0.10），每日平均呕吐频率从2.11降至0.11（p = 0.03）。在第二疗程预防性使用阿瑞匹坦（n = 18）使无明显恶心的患者比例从6%（第一疗程）增至50%（第二疗程；p = 0.007），无呕吐的患者比例从33%增至89%（p = 0.002）。使用阿瑞匹坦在第二疗程也显著改善了CINV相关的生活质量。
超过一半接受HEC的患者和88%接受MEC的患者未使用阿瑞匹坦。阿瑞匹坦对真正需要的患者的CINV显示出显著的治疗和预防效果。
