Miya Toshimichi, Kobayashi Kunihiko, Hino Mitsunori, Ando Masahiro, Takeuchi Susumu, Seike Masahiro, Kubota Kaoru, Gemma Akihiko
Department of Pulmonary Medicine/Medical Oncology, Nippon Medical School, Tamanagayama Hospital, 1-7-1 Nagayama, Tama, Tokyo 206-8512 Japan.
Department of Pulmonary Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama Japan.
Springerplus. 2016 Dec 7;5(1):2080. doi: 10.1186/s40064-016-3769-x. eCollection 2016.
Chemotherapy-induced nausea and vomiting (CINV) is a major adverse toxicity of cancer chemotherapy. Recommended treatments for prevention of CINV vary among published guidelines, and optimal care for CINV caused by moderately emetogenic chemotherapy has not been established. This study assessed the efficacy and safety of triple antiemetic therapy comprising palonosetron, dexamethasone and aprepitant for carboplatin-based chemotherapy. Chemotherapy-naïve patients with lung cancer scheduled for a first course of a carboplatin-containing regimen formed the study cohort. Patients were pretreated with antiemetic therapy comprising palonosetron (0.75 mg, i.v.) and dexamethasone (9.9 mg, i.v.) on day 1, and aprepitant (125 mg, p.o.) on day 1 followed by 80 mg on days 2 and 3. Primary endpoint was the proportion of patients who did not experience vomiting and did not require rescue medication [complete response (CR)] in the acute phase (0-24 h), late phase (24-168 h) and overall. Secondary endpoint was the proportion of patients who experienced no vomiting episodes and no more than mild nausea without the need for rescue medication [complete control (CC)].
Prevalence of a CR during the acute phase, delayed phase, and overall was 100, 91.9 and 91.9%, whereas that of CC was 100, 84.4 and 84.4%, respectively. The most common adverse event was mild constipation; severe adverse events related to antiemetic treatment were not observed.
Triple antiemetic therapy comprising palonosetron, dexamethasone and aprepitant shows excellent effects in the prevention of CINV in patients receiving a carboplatin-containing regimen.
化疗引起的恶心和呕吐（CINV）是癌症化疗的主要不良毒性反应。已发表的指南中推荐的预防CINV的治疗方法各不相同，对于中度致吐性化疗引起的CINV的最佳治疗方案尚未确立。本研究评估了由帕洛诺司琼、地塞米松和阿瑞匹坦组成的三联止吐疗法对基于卡铂的化疗的疗效和安全性。计划接受含卡铂方案首个疗程治疗的初治肺癌患者构成了研究队列。患者在第1天接受包含帕洛诺司琼（0.75mg，静脉注射）和地塞米松（9.9mg，静脉注射）的止吐治疗，在第1天口服阿瑞匹坦（125mg），随后在第2天和第3天口服80mg。主要终点是在急性期（0 - 24小时）、延迟期（24 - 168小时）及总体上未经历呕吐且不需要救援药物的患者比例[完全缓解（CR）]。次要终点是未经历呕吐发作且仅有不超过轻度恶心且不需要救援药物的患者比例[完全控制（CC）]。
急性期、延迟期及总体的CR发生率分别为100%、91.9%和91.9%，而CC发生率分别为100%、84.4%和84.4%。最常见的不良事件是轻度便秘；未观察到与止吐治疗相关的严重不良事件。
由帕洛诺司琼、地塞米松和阿瑞匹坦组成的三联止吐疗法在预防接受含卡铂方案治疗的患者的CINV方面显示出优异效果。
