Schwartzberg Lee S, Rugo Hope S, Aapro Matti S
The University of Tennessee Health Science Center, Memphis, Tennessee.
Clin Adv Hematol Oncol. 2015 Mar;13(3 Suppl 3):3-13, 1; quiz 2 p following 14.
Chemotherapy-induced nausea and vomiting (CINV) remains one of the most challenging adverse events of chemotherapy, and one that has substantial negative effects on patients, clinicians, and the wider health care system. Use of CINV prophylaxis consistent with clinical practice guidelines is essential for attaining optimal CINV control. In recent years, there has been a dramatic improvement in the control of CINV with the introduction of effective antiemetic agents, including the serotonin (5-hydroxytryptamine [5-HT3]) receptor antagonists (ondansetron, granisetron, and palonosetron) and the neurokinin-1 (NK1) receptor antagonists (aprepitant and fosaprepitant). An important benefit of the newer antiemetic agents is their improved ability to control the delayed CINV that can develop in the days after chemotherapy administration. In October 2014, a fixed-dose oral combination containing the novel NK1 receptor antagonist netupitant and palonosetron (NEPA) received approval from the US Food and Drug Administration. The combination of 2 effective antiemetic agents in a single, oral capsule may help simplify CINV management. Ongoing studies are evaluating new CINV approaches (eg, the novel NK1 receptor antagonist rolapitant), as well as the optimal use of existing therapies. Patient education regarding the timing, prevention, and treatment of CINV is another key component of CINV management.
化疗引起的恶心和呕吐（CINV）仍然是化疗最具挑战性的不良事件之一，对患者、临床医生及更广泛的医疗保健系统均有重大负面影响。按照临床实践指南使用CINV预防措施对于实现最佳的CINV控制至关重要。近年来，随着有效止吐药的引入，包括5-羟色胺（5-HT3）受体拮抗剂（昂丹司琼、格拉司琼和帕洛诺司琼）和神经激肽-1（NK1）受体拮抗剂（阿瑞匹坦和福沙匹坦），CINV的控制有了显著改善。新型止吐药的一个重要益处是它们控制化疗给药后数天可能出现的迟发性CINV的能力有所提高。2014年10月，一种含有新型NK1受体拮抗剂奈妥匹坦和帕洛诺司琼（NEPA）的固定剂量口服复方制剂获得了美国食品药品监督管理局的批准。将两种有效的止吐药组合在一个口服胶囊中可能有助于简化CINV的管理。正在进行的研究正在评估新的CINV治疗方法（如新型NK1受体拮抗剂罗拉匹坦）以及现有疗法的最佳使用。关于CINV的发生时间、预防和治疗的患者教育是CINV管理的另一个关键组成部分。
