Toda Haruka, Kawazoe Hitoshi, Yano Akiko, Yamamoto Yuji, Watanabe Yuji, Yamamoto Yasunori, Hiasa Yoichi, Yakushijin Yoshihiro, Tanaka Akihiro, Araki Hiroaki
Division of Pharmacy, Ehime University Hospital, Shitsukawa, Toon, Ehime 791-0295, Japan.
Division of Gastrointestinal Surgery and Surgical Oncology, Department of Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan.
J Cancer. 2017 May 12;8(8):1371-1377. doi: 10.7150/jca.17102. eCollection 2017.
The therapeutic benefit of a three-drug combination of antiemetics has not been established in moderately emetogenic chemotherapy (MEC). The aim of this study was to compare the antiemetic effectiveness and cost-saving of palonosetron plus dexamethasone (control group) with aprepitant, granisetron, and dexamethasone (study group) in cancer patients who received MEC. We switched the standard antiemetic treatment from the control group to the study group in gastrointestinal cancer patients who received MEC after October 2015. The antiemetics in both groups were modified using salvage antiemetic therapy at the clinicians' discretion, according to the severity of chemotherapy-induced nausea and vomiting. We retrospectively reviewed the electronic medical records from patients, before and after switching groups, from between April 2014 and March 2016. We evaluated 443 treatment courses in 83 patients. The proportion of courses that included salvage antiemetic therapy in the control group and the study group was 34.8 % (116/333) and 8.2 % (9/110), respectively, and was statistically significant ( < 0.001). The mean integrated costs of antiemetics per course in the control group and the study group were 193 ± 55 USD and 143 ± 38 USD, respectively. Multivariate logistic regression analysis revealed that the study group was significantly associated with a reduced risk of requiring salvage antiemetic therapy ( = 0.038). These results suggest that the antiemetic effectiveness and cost-saving of a three-drug combination of aprepitant, generic granisetron, and dexamethasone was superior to a two-drug combination of palonosetron plus dexamethasone in gastrointestinal cancer patients who received MEC.
在中度致吐性化疗（MEC）中，三种止吐药联合使用的治疗效果尚未得到证实。本研究的目的是比较在接受MEC的癌症患者中，帕洛诺司琼加地塞米松（对照组）与阿瑞匹坦、格拉司琼和地塞米松（研究组）的止吐效果和成本节约情况。2015年10月后，我们将接受MEC的胃肠道癌症患者的标准止吐治疗从对照组改为研究组。两组的止吐药均根据化疗引起的恶心和呕吐的严重程度，由临床医生酌情使用挽救性止吐疗法进行调整。我们回顾性分析了2014年4月至2016年3月期间患者在分组前后的电子病历。我们评估了83例患者的443个疗程。对照组和研究组中包括挽救性止吐疗法的疗程比例分别为34.8%（116/333）和8.2%（9/110），差异有统计学意义（<0.001）。对照组和研究组每个疗程止吐药的平均综合成本分别为193±55美元和143±38美元。多因素逻辑回归分析显示，研究组与需要挽救性止吐疗法的风险降低显著相关（=0.038）。这些结果表明，在接受MEC的胃肠道癌症患者中，阿瑞匹坦、普通格拉司琼和地塞米松三联用药的止吐效果和成本节约优于帕洛诺司琼加地塞米松二联用药。
