Dennis K, De Angelis C, Jon F, Lauzon N, Pasetka M, Holden L, Barnes E, Danjoux C, Sahgal A, Tsao M, Chow E
Division of Radiation Oncology, The Ottawa Hospital and University of Ottawa, and The Ottawa Hospital Research Institute, Ottawa, ON.
Department of Pharmacy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON.
Curr Oncol. 2014 Dec;21(6):e760-7. doi: 10.3747/co.21.2051.
We evaluated the novel combination of aprepitant and granisetron for the prophylaxis of radiotherapy-induced nausea and vomiting (rinv) among patients receiving moderately-emetogenic radiotherapy for thoracolumbar bone metastases.
In this single-centre two-arm nonrandomized prospective pilot study, patients undergoing single-fraction radiotherapy (8 Gy) received aprepitant 125 mg and granisetron 2 mg on the day of radiotherapy and aprepitant 80 mg on each of the first 2 days after the day of radiotherapy. Patients undergoing multiple-fraction radiotherapy (20 Gy in 5 fractions) received aprepitant 125 mg on day 1 of radiotherapy, aprepitant 80 mg on days 3 and 5 of radiotherapy, and granisetron 2 mg on every day of radiotherapy. Symptoms and total medication intake were recorded daily during the acute phase (day 1 of radiotherapy until the first day after the last day of radiotherapy), and the delayed phase (days 2-10 after the last day of radiotherapy). Control of vomiting, retching, and nausea was defined as no symptoms and no use of rescue medication.
Control rates for single-fraction patients (n = 13) were 100% for acute nausea, 62% for delayed nausea, 100% for acute vomiting and retching, and 85% for delayed vomiting and retching. Control rates for multiple-fraction patients (n = 6) were 67% for acute nausea, 83% for delayed nausea, 67% for acute vomiting and retching, and 83% for delayed vomiting and retching. No grade 3 or 4 toxicities attributable to the study intervention were observed.
The combination of aprepitant and granisetron was safe and efficacious for the prophylaxis of rinv after both single- and multiple-fraction moderately emetogenic radiotherapy for thoracolumbar bone metastases. Our results require confirmation in a larger population.
我们评估了阿瑞匹坦与格拉司琼联合用药对接受中致吐性放疗的胸腰椎骨转移患者放疗引起的恶心和呕吐（RINV）的预防效果。
在这项单中心双臂非随机前瞻性试验研究中，接受单次分割放疗（8 Gy）的患者在放疗当天接受125 mg阿瑞匹坦和2 mg格拉司琼，放疗后第一天后的前两天每天接受80 mg阿瑞匹坦。接受多次分割放疗（5次分割共20 Gy）的患者在放疗第1天接受125 mg阿瑞匹坦，放疗第3天和第5天接受80 mg阿瑞匹坦，放疗期间每天接受2 mg格拉司琼。在急性期（放疗第1天至放疗最后一天后的第一天）和延迟期（放疗最后一天后的第2 - 10天）每天记录症状和总药物摄入量。呕吐、干呕和恶心的控制定义为无症状且未使用急救药物。
单次分割放疗患者（n = 13）急性恶心的控制率为100%，延迟性恶心为62%，急性呕吐和干呕为100%，延迟性呕吐和干呕为85%。多次分割放疗患者（n = 6）急性恶心的控制率为67%，延迟性恶心为83%，急性呕吐和干呕为67%，延迟性呕吐和干呕为83%。未观察到与研究干预相关的3级或4级毒性反应。
对于胸腰椎骨转移患者，在单次和多次分割中致吐性放疗后，阿瑞匹坦与格拉司琼联合用药对预防RINV安全有效。我们的结果需要在更大规模人群中得到证实。
