Tamura Kazuo, Aiba Keisuke, Saeki Toshiaki, Nakanishi Yoichi, Kamura Toshiharu, Baba Hideo, Yoshida Kazuhiro, Yamamoto Nobuyuki, Kitagawa Yuko, Maehara Yoshihiko, Shimokawa Mototsugu, Hirata Koichi, Kitajima Masaki
General Medical Research Center, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka-shi, Fukuoka, 814-0180, Japan.
Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
Int J Clin Oncol. 2017 Apr;22(2):405-412. doi: 10.1007/s10147-016-1069-7. Epub 2016 Dec 1.
We conducted a nationwide survey on chemotherapy-induced nausea and vomiting (CINV) in Japan and demonstrated good compliance with Japanese CINV guidelines, resulting in good control of vomiting. However, almost half the patients experienced breakthrough CINV. We analyzed the survey results in relationship to the management of patients with breakthrough CINV.
This multicenter, prospective, observational study analyzed data for 1910 patients in Japan scheduled for moderately or highly emetogenic chemotherapy (MEC and HEC, respectively). Patients who developed CINV despite prophylactic use of antiemetics were administered rescue drugs. Patients who received cisplatin-based HEC (C-HEC), non-cisplatin-based HEC (N-HEC), or MEC were evaluated separately.
A total of 989 patients experienced CINV, of whom 412 (44%) received rescue antiemetics during the study period. The rate at which patients with breakthrough CINV were started on rescue drugs ranged from 13% to 24%. Rescue drugs were given more frequently on days 2-4 for C-HEC and MEC and on days 1-2 for N-HEC. Eighty-six percent of patients received metoclopramide or domperidone. 5-HT receptor antagonists, antipsychotics, and anti-anxiety drugs were used for 11-5% of patients. The mean duration of antiemetic use was 2.6 days.
Fewer than half of the patients with breakthrough CINV were treated with rescue antiemetics, suggesting that CINV was mild in the remaining patients. However, CINV was sufficiently severe to prevent eating in other patients, indicating the need for new drugs with different mechanisms to control CINV.
我们在日本开展了一项关于化疗引起的恶心和呕吐（CINV）的全国性调查，结果显示对日本CINV指南的依从性良好，呕吐得到了有效控制。然而，近一半的患者经历了突破性CINV。我们分析了调查结果与突破性CINV患者管理的关系。
这项多中心、前瞻性、观察性研究分析了日本1910例计划接受中度或高度致吐性化疗（分别为MEC和HEC）患者的数据。尽管预防性使用了止吐药仍发生CINV的患者接受了救援药物治疗。分别对接受基于顺铂的HEC（C-HEC）、非基于顺铂的HEC（N-HEC）或MEC的患者进行了评估。
共有989例患者发生CINV，其中412例（44%）在研究期间接受了救援止吐药。突破性CINV患者开始使用救援药物的比例在13%至24%之间。对于C-HEC和MEC，救援药物在第2-4天使用得更频繁，对于N-HEC，在第1-2天使用得更频繁。86%的患者接受了甲氧氯普胺或多潘立酮。5-HT受体拮抗剂、抗精神病药和抗焦虑药用于11%-5%的患者。止吐药的平均使用时间为2.6天。
不到一半的突破性CINV患者接受了救援止吐药治疗，这表明其余患者的CINV较轻。然而，CINV在其他患者中严重到足以影响进食，这表明需要具有不同作用机制的新药来控制CINV。
