Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China.
Department of Clinical Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People's Republic of China.
Oncologist. 2018 May;23(5):603-616. doi: 10.1634/theoncologist.2017-0378. Epub 2018 Jan 12.
The current antiemetic prophylaxis for patients treated with highly emetogenic chemotherapy (HEC) included the olanzapine-based triplet and neurokinin-1 receptor antagonists (NK-1RAs)-based triplet. However, which one shows better antiemetic effect remained unclear.
We systematically reviewed 43 trials, involving 16,609 patients with HEC, which compared the following antiemetics at therapeutic dose range for the treatment of chemotherapy-induced nausea and vomiting: olanzapine, aprepitant, casopitant, fosaprepitant, netupitant, and rolapitant. The main outcomes were the proportion of patients who achieved no nausea, complete response (CR), and drug-related adverse events. A Bayesian network meta-analysis was performed.
Olanzapine-based triple regimens showed significantly better no-nausea rate in overall phase and delayed phase than aprepitant-based triplet (odds ratios 3.18, 3.00, respectively), casopitant-based triplet (3.78, 4.12, respectively), fosaprepitant-based triplet (3.08, 4.10, respectively), rolapitant-based triplet (3.45, 3.20, respectively), and conventional duplex regimens (4.66, 4.38, respectively). CRs of olanzapine-based triplet were roughly equal to different NK-1RAs-based triplet but better than the conventional duplet. Moreover, no significant drug-related adverse events were observed in olanzapine-based triple regimens when compared with NK-1RAs-based triple regimens and duplex regimens. Additionally, the costs of olanzapine-based regimens were obviously much lower than the NK-1RA-based regimens.
Olanzapine-based triplet stood out in terms of nausea control and drug price but represented no significant difference of CRs in comparison with NK-1RAs-based triplet. Olanzapine-based triple regimens should be an optional antiemetic choice for patients with HEC, especially those suffering from delayed phase nausea.
According to the results of this study, olanzapine-based triple antiemetic regimens were superior in both overall and delayed-phase nausea control when compared with various neurokinin-1 receptor antagonists-based triple regimens in patients with highly emetogenic chemotherapy (HEC). Olanzapine-based triplet was outstanding in terms of nausea control and drug price. For cancer patients with HEC, especially those suffering from delayed-phase nausea, olanzapine-based triple regimens should be an optional antiemetic choice.
目前，接受高致吐化疗（HEC）治疗的患者的止吐预防方案包括奥氮平为基础的三联方案和神经激肽-1 受体拮抗剂（NK-1RAs）为基础的三联方案。然而，哪种方案的止吐效果更好尚不清楚。
我们系统地回顾了 43 项试验，涉及 16609 例接受 HEC 治疗的患者，这些试验比较了以下治疗化疗引起的恶心和呕吐的治疗剂量范围内的止吐药：奥氮平、阿瑞匹坦、卡索匹坦、福沙匹坦、奈妥匹坦和罗拉匹坦。主要结局是无恶心、完全缓解（CR）和药物相关不良事件的患者比例。进行了贝叶斯网络荟萃分析。
奥氮平为基础的三联方案在总体相和延迟相的无恶心发生率明显优于阿瑞匹坦为基础的三联方案（比值比分别为 3.18、3.00）、卡索匹坦为基础的三联方案（3.78、4.12）、福沙匹坦为基础的三联方案（3.08、4.10）、罗拉匹坦为基础的三联方案（3.45、3.20）和常规双联方案（4.66、4.38）。奥氮平为基础的三联方案的 CR 大致与不同的 NK-1RAs 为基础的三联方案相当，但优于常规双联方案。此外，与 NK-1RAs 为基础的三联方案和双联方案相比，奥氮平为基础的三联方案未观察到明显的药物相关不良事件。此外，奥氮平为基础的方案的成本明显低于 NK-1RA 为基础的方案。
奥氮平为基础的三联方案在控制恶心和药物价格方面表现突出，但与 NK-1RAs 为基础的三联方案相比，CR 方面无显著差异。对于接受 HEC 治疗的患者，奥氮平为基础的三联方案应作为一种可选的止吐药物选择，尤其是那些有迟发性恶心的患者。
根据本研究结果，与各种神经激肽-1 受体拮抗剂为基础的三联方案相比，奥氮平为基础的三联方案在接受高致吐化疗（HEC）的患者中，无论是在总体相还是延迟相，在控制恶心方面均具有优势。奥氮平为基础的三联方案在控制恶心和药物价格方面表现突出。对于接受 HEC 治疗的癌症患者，尤其是那些有迟发性恶心的患者，奥氮平为基础的三联方案应作为一种可选的止吐药物选择。
