Division of Breast Medical Oncology, Department of Breast and Thoracic Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italy.
Medical Oncology Department, "A.O.U. Città della Scienza e della Salute di Torino", Turin, Italy.
Support Care Cancer. 2018 Dec;26(12):4021-4029. doi: 10.1007/s00520-018-4259-1. Epub 2018 Jun 25.
Chemotherapy-induced nausea and vomiting (CINV) is a common adverse event with cancer chemotherapy, despite the availability of effective antiemetic agents. This is a prospective observational study of Italian breast cancer patients treated with anthracycline plus cyclophosphamide (AC), assessed CINV incidence, adherence to national antiemetic guidelines (AIOM 2012), and the relationship with CINV outcomes.
Patients with breast cancer scheduled to receive their first cycle of an AC-based regimen were enrolled at 12 Italian centers and their clinical data prospectively recorded. CINV incidence was assessed from patient diaries after the first chemotherapy cycle. The relationship between guideline adherence and CINV outcomes was examined using multiple logistic regression.
The overall incidence rates of nausea and vomiting among 246 evaluable patients were 63.0 and 25.4%, respectively. Most patients received a 5-HT3-RA agent and dexamethasone for acute phase CINV prophylaxis, whereas a triple combination including aprepitant (NK1-RA), consistent with national guidelines, was used in only 45.5% of cases. In the delayed phase, the guideline adherence was 48.8%, while the overall adherence was 43.5%. After adjusting for confounding factors, adherence to antiemetic prophylaxis guidelines was associated with a significant reduction in the odds of three endpoints, namely any nausea, "significant nausea," and vomiting (OR = 0.49, OR = 0.54, and OR = 0.48, respectively), and a 90% increase in the odds of overall complete protection (OR = 1.90).
CINV is still a critical issue in AC-treated patients, despite antiemetic treatment. Non-adherence to antiemetic guidelines may lead to poorer outcomes and indicates the need for strategies to enhance the use of guidelines in clinical practice.
尽管有有效的止吐药物，但化疗引起的恶心和呕吐（CINV）仍是癌症化疗的常见不良反应。这是一项对接受蒽环类药物加环磷酰胺（AC）治疗的意大利乳腺癌患者进行的前瞻性观察研究，评估了 CINV 的发生率、对国家止吐指南（AIOM 2012）的依从性以及与 CINV 结局的关系。
在 12 个意大利中心招募了计划接受首个 AC 方案化疗的乳腺癌患者，并前瞻性地记录了他们的临床数据。从第一个化疗周期后的患者日记中评估 CINV 的发生率。使用多因素逻辑回归分析指南依从性与 CINV 结局的关系。
在 246 例可评估患者中，恶心和呕吐的总发生率分别为 63.0%和 25.4%。大多数患者接受了 5-HT3-RA 药物和地塞米松预防急性 CINV，而只有 45.5%的患者使用了包括阿瑞匹坦（NK1-RA）在内的三联方案，符合国家指南。在迟发性阶段，指南的依从性为 48.8%，而总体依从性为 43.5%。调整混杂因素后，抗呕吐预防指南的依从性与以下三个终点的几率显著降低相关，即任何程度的恶心、“显著恶心”和呕吐（OR=0.49、OR=0.54 和 OR=0.48），以及总体完全保护的几率增加 90%（OR=1.90）。
尽管有止吐治疗，AC 治疗的患者中 CINV 仍然是一个关键问题。不遵守止吐指南可能导致结局较差，表明需要制定策略来增强指南在临床实践中的应用。
