Ruhlmann Christina H, Herrstedt Jørn
a Department of Oncology , Aarhus University Hospital , Aarhus , Denmark.
b Department of Oncology, and Institute of Clinical Research , Odense University Hospital, University of Southern Denmark , Odense , Denmark.
Expert Opin Pharmacother. 2016 Aug;17(12):1623-9. doi: 10.1080/14656566.2016.1202923. Epub 2016 Jun 27.
Antiemetic prophylaxis for the prevention of chemotherapy-induced nausea and vomiting, and the development of new antiemetic drugs are expanding areas of research. However, studies of antiemetic prophylaxis in chemoradiotherapy have not been prioritised, and little is known about the proper timing, duration, and combination of antiemetic drugs for the prevention of chemoradiotherapy-induced nausea and vomiting (C-RINV).
The article summarises the available antiemetic studies, the evidence for antiemetic prophylaxis of C-RINV, and the future perspectives for antiemetic research in chemoradiotherapy.
Antiemetic prophylaxis for patients receiving concomitant chemoradiotherapy has, for many years, been an orphan research area. The distinction between acute and delayed nausea and vomiting does not apply to fractionated radiotherapy, and prophylaxis should be considered to cover the entire course of treatment and not only the acute and delayed chemotherapy-induced nausea and vomiting. The best prophylaxis in women receiving fractionated radiotherapy and concomitant weekly cisplatin is a combination of the neurokinin receptor antagonist fosaprepitant with palonosetron and dexamethasone. Even with this three-drug combination nausea is a significant problem and the effect of multi-receptor targeting antiemetics such as olanzapine and amisulpride should be explored in this setting.
用于预防化疗引起的恶心和呕吐的止吐预防措施以及新型止吐药物的研发是不断扩展的研究领域。然而，放化疗中关于止吐预防的研究尚未得到足够重视，对于预防放化疗引起的恶心和呕吐（C-RINV）的止吐药物的恰当给药时间、持续时间及联合用药知之甚少。
本文总结了现有的止吐研究、C-RINV止吐预防的证据以及放化疗中止吐研究的未来展望。
多年来，接受同步放化疗患者的止吐预防一直是一个被忽视的研究领域。急性和迟发性恶心呕吐的区分并不适用于分次放疗，应考虑进行全程预防，而不仅仅是预防急性和迟发性化疗引起的恶心呕吐。对于接受分次放疗并同步每周使用顺铂的女性患者，最佳的预防方案是将神经激肽受体拮抗剂福沙匹坦与帕洛诺司琼和地塞米松联合使用。即便采用这种三联药物组合，恶心仍是一个严重问题，在此情况下应探索多受体靶向止吐药如奥氮平和阿立哌唑的效果。
