Wang Shi-Yong, Yang Zhen-Jun, Zhang Lu
Department of Biotherapy and Laboratory of Biotherapy, the Fourth Affiliated Hospital of China Medical University, Shenyang, China E-mail :
Asian Pac J Cancer Prev. 2014;15(22):9587-92. doi: 10.7314/apjcp.2014.15.22.9587.
Nausea and vomiting are common adverse events in chemotherapy. In spite of the serious effects on the quality of life and further treatment, they remain overlooked by physicians, and no standard treatment has been developed. Neurokinin-1 (NK-1) receptor antagonists and palonosetron are the major agents in the standard regimen for treating moderately and highly emetogenic chemotherapy-induced nausea and vomiting (CINV). However, NK-1 receptor antagonists first became commercially available at the end of 2013 and palonosetron has not been extensively applied in China. Olanzapine was recommended as a therapy for moderate and severe CINV in antiemesis-clinical practice guidelines in oncology in 2014 for the first time. It is an atypical antipsychotic agent, which can block multiple receptors on neurotransmitters. During more than 10 years, olanzapine has demonstrated significant effects in preventing CINV and treating breakthrough and refractor CINV, which was observed in case reports, precise retrospective studies, and phase I, II and III clinical trials, with no grade 3 to 4 adverse events. In particular, it is superior to aprepitant and dexamethasone in delayed nausea and vomiting. Therefore, this compound is worthy of further investigation.
恶心和呕吐是化疗中常见的不良事件。尽管它们对生活质量和后续治疗有严重影响，但仍被医生忽视，且尚未开发出标准治疗方法。神经激肽-1（NK-1）受体拮抗剂和帕洛诺司琼是治疗中度和高度致吐性化疗引起的恶心和呕吐（CINV）的标准方案中的主要药物。然而，NK-1受体拮抗剂于2013年底首次上市，而帕洛诺司琼在中国尚未得到广泛应用。奥氮平于2014年首次在肿瘤学止吐临床实践指南中被推荐用于治疗中度和重度CINV。它是一种非典型抗精神病药物，可阻断神经递质上的多种受体。在十多年的时间里，奥氮平在预防CINV以及治疗突破性和难治性CINV方面已显示出显著效果，这在病例报告、精确的回顾性研究以及I、II和III期临床试验中均有观察到，且无3至4级不良事件。特别是，它在延迟性恶心和呕吐方面优于阿瑞匹坦和地塞米松。因此，这种化合物值得进一步研究。
