Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, 600020, India.
Department of Psycho-oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, 600020, India.
Med Oncol. 2017 Dec 16;35(1):12. doi: 10.1007/s12032-017-1074-3.
Chemotherapy-induced nausea-vomiting (CINV) compromises the quality of life of patients with cancer. We present data on the effectiveness of olanzapine after failure of aprepitant in patients receiving highly emetogenic chemotherapy (HEC). A single-center prospective study was conducted, where patients ≥ 18 years who failed aprepitant, palonosetron, dexamethasone (APD) received olanzapine, palonosetron and dexamethasone (OPD) in the subsequent cycle of HEC. Failure of APD was defined as occurrence of ≥ grade 2 acute and/or delayed nausea ± vomiting. Response rates were compared with what was achieved in their previous cycle with the use of APD in the acute (0-24 h), delayed (24-120 h) and overall (0-120 h) periods after the start of HEC. Impact on life was assessed using the MD Anderson Symptom Inventory (MDASI). Fifty-five patients failed APD and received OPD in the subsequent cycle; 54 were evaluable for response. Complete response rate for OPD versus APD is 80 versus 20% (acute period), 90 versus 18% (delayed period) and 74 versus 5% (overall period), and no nausea rate for OPD versus APD is 57 versus 13% (acute), 59 versus 15% (delayed) and 48 versus 0% (overall period), p < 0.001 for all comparisons. MDASI scores showed significant improvement after switching to OPD. A mild increase in drowsiness noted in patients receiving OPD did not affect daily life in most patients. In patients receiving HEC and failing CINV prophylaxis with APD, switching to OPD regimen in the subsequent cycle greatly improves control of vomiting, increases "no nausea" rates and significantly reduces symptom severity scores.
化疗引起的恶心和呕吐（CINV）会降低癌症患者的生活质量。我们报告了阿瑞匹坦失败后接受高度致吐性化疗（HEC）的患者使用奥氮平的有效性数据。进行了一项单中心前瞻性研究，其中在接受 APD（阿瑞匹坦、帕洛诺司琼、地塞米松）治疗失败的≥18 岁患者在接受 HEC 的下一个周期中接受奥氮平、帕洛诺司琼和地塞米松（OPD）。APD 治疗失败的定义为出现≥2 级急性和/或迟发性恶心±呕吐。通过比较患者在使用 APD 治疗的急性（0-24 小时）、迟发性（24-120 小时）和总体（0-120 小时）期间的反应率与他们在前一个周期中使用 APD 时的反应率来比较。使用 MD 安德森症状评估量表（MDASI）评估对生活的影响。55 例患者在接受 APD 治疗后失败，并在下一个周期中接受 OPD 治疗；54 例患者可评估反应。OPD 对 APD 的完全缓解率分别为 80%对 20%（急性期）、90%对 18%（迟发性）和 74%对 5%（总体），OPD 对 APD 的无恶心率分别为 57%对 13%（急性）、59%对 15%（迟发性）和 48%对 0%（总体），所有比较均 p<0.001。转换为 OPD 后，MDASI 评分显著改善。接受 OPD 治疗的患者出现轻微的嗜睡增加，但这并未影响大多数患者的日常生活。在接受 HEC 治疗且 APD 预防 CINV 失败的患者中，在下一个周期中转换为 OPD 方案可大大改善呕吐控制，增加“无恶心”率，并显著降低症状严重程度评分。
