Yoshida Naohisa, Taguchi Tetsuya, Nakanishi Masayoshi, Inoue Ken, Okayama Tetsuya, Ishikawa Takeshi, Otsuji Eigo, Takayama Koichi, Kuroboshi Haruo, Kanazawa Motohiro, Itoh Yoshito
Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
Outpatient Cancer Chemotherapy Center, Kyoto Prefectural University of Medicine Hospital, Kyoto, Japan.
BMC Pharmacol Toxicol. 2019 Jan 14;20(1):6. doi: 10.1186/s40360-018-0278-2.
Nausea is more difficult to control than vomiting in chemotherapy. We therefore analyzed the efficacy of a strong supportive treatment with aprepitant, palonosetron, and dexamethasone against nausea for various moderately emetogenic chemotherapy (MEC).
A total of 312 cases treated by palonosetron with or without aprepitant receiving MEC regimens using oxaliplatin, carboplatin, and irinotecan from 2014 to 2016 in our outpatient center for digestive organ cancers, lung cancers, and gynecological cancers were analyzed. Through propensity score matching analysis, cases were divided into 97 cases receiving 2 drugs (palonosetron+dexamethasone) and 97 receiving 3 drugs (aprepitant+palonosetron+dexamethasone). We examined the control rates of nausea for the first two consecutive courses in the both groups. Additionally, risk factors for acute and delayed nausea were analyzed using a multivariate analysis among overall 312 cases.
The control rates of nausea in the two- and the three-drug groups were as follows: acute, 92.8 and 95.9% (p = 0.35); and delayed, 83.5 and 81.4% (p = 0.85), although the control rates of vomiting exceeded 95% in both groups. A multivariate analysis showed that significant risk factors for acute nausea (odds ratio, 95% confidence interval) were elevation of serum creatinine (12.601, 2.437-65.157), general fatigue (3.728, 1.098-12.661), and performance status (PS) 2 (19.829, 3.200-122.865). The significant risk factors for delayed nausea were elevation of alanine aminotransferase (2.397, 1.153-4.984), general fatigue (2.652, 1.380-5.097), and PS 2 (5.748, 1.392-23.740).
The control for nausea in MEC was insufficient even with palonosetron and aprepitant, and we should pay attention to risk factors for preventing nausea.
在化疗中，恶心比呕吐更难控制。因此，我们分析了阿瑞匹坦、帕洛诺司琼和地塞米松联合进行强化支持治疗对各种中度致吐性化疗（MEC）所致恶心的疗效。
对2014年至2016年在我院消化器官癌、肺癌和妇科癌门诊中心接受含奥沙利铂、卡铂和伊立替康的MEC方案治疗的312例患者进行分析，这些患者接受了帕洛诺司琼治疗，部分联合阿瑞匹坦。通过倾向评分匹配分析，将患者分为97例接受两种药物治疗（帕洛诺司琼+地塞米松）和97例接受三种药物治疗（阿瑞匹坦+帕洛诺司琼+地塞米松）。我们检查了两组连续两个疗程的恶心控制率。此外，对312例患者进行多因素分析，分析急性和延迟性恶心的危险因素。
两药组和三药组的恶心控制率如下：急性恶心，分别为92.8%和95.9%（p = 0.35）；延迟性恶心，分别为83.5%和81.4%（p = 0.85），尽管两组呕吐控制率均超过95%。多因素分析显示，急性恶心的显著危险因素（比值比，95%置信区间）为血清肌酐升高（12.601，2.437 - 65.157）、全身乏力（3.728，1.098 - 12.661）和体能状态（PS）为2（19.829，3.200 - 122.865）。延迟性恶心的显著危险因素为丙氨酸转氨酶升高（2.397，1.153 - 4.984）、全身乏力（2.652，1.380 - 5.097）和PS为2（5.748，1.392 - 23.740）。
即使使用帕洛诺司琼和阿瑞匹坦，MEC中恶心的控制仍不充分，我们应关注预防恶心的危险因素。
