Thakerar Arti, Simadri Karishma, Alexander Marliese, Fullerton Sonia
Department of Pharmacy, Peter MacCallum Cancer Centre, Melbourne, Australia.
Department of Pharmacy, Monash Health, Clayton, Australia.
J Oncol Pharm Pract. 2020 Jun;26(4):803-808. doi: 10.1177/1078155219870594. Epub 2019 Aug 25.
Intractable and persistent cough is experienced by more than a third of patients with advanced cancer, with a significant negative impact on quality of life. Pharmacological treatment has been of little help in some patients. Limited evidence suggests novel agents such as paroxetine may reduce cough severity. This retrospective study aimed to assess effectiveness and tolerability of paroxetine for the treatment of intractable cough in patients with cancer.
Single-centre medical record review of paroxetine use in patients with advanced malignancy and cough treated at an Australia tertiary referral cancer centre between 1 October 2012 and 1 October 2017. Data relating to cough type and severity, response and adverse events were extracted from medical records. Cough type was described as non-productive dry cough, productive chesty cough or cough exhibiting both non-productive and productive features (mixed cough).
Overall, 24/34 patients (71%) experienced a major or moderate reduction in their cough severity after treatment with paroxetine. Nearly half (47%) described a major improvement and a quarter (24%) moderate improvement. Of the 34 patients, nearly half had a lung primary cancer (16/34, 47%) and nearly all (17/18) of those without lung cancer had lung metastases from another primary cancer. Patients with dry cough reported greater benefit from paroxetine. Of the 56% (19/34) of patients with non-productive dry cough, 80% (15/19) reported an improvement in symptoms post paroxetine. The remaining 15 patients, 44% of the group, presented with either a productive chesty cough (9/34, 27%) or mixed cough (6/34, 18%). Of these patients, 60% (9/15) reported an improvement in symptoms. Two thirds of patients were commenced on paroxetine 10 mg (22/34, 65%), with the remainder starting at 20 mg (14/34, 35%).
Paroxetine may be an effective, novel, off-label treatment for intractable and persistent cough in patients with advanced cancer.
超过三分之一的晚期癌症患者经历过顽固且持续的咳嗽，这对生活质量有显著负面影响。药物治疗对一些患者帮助不大。有限的证据表明，诸如帕罗西汀等新型药物可能会减轻咳嗽严重程度。这项回顾性研究旨在评估帕罗西汀治疗癌症患者顽固性咳嗽的有效性和耐受性。
对2012年10月1日至2017年10月1日期间在澳大利亚一家三级转诊癌症中心接受治疗的晚期恶性肿瘤和咳嗽患者使用帕罗西汀的情况进行单中心病历审查。从病历中提取与咳嗽类型和严重程度、反应及不良事件相关的数据。咳嗽类型被描述为无痰干咳、有痰的胸部咳嗽或兼具无痰和有痰特征的咳嗽（混合性咳嗽）。
总体而言，24/34名患者（71%）在接受帕罗西汀治疗后咳嗽严重程度有大幅或中度减轻。近一半（47%）的患者表示有显著改善，四分之一（24%）的患者表示有中度改善。在这34名患者中，近一半患有原发性肺癌（16/34，47%），几乎所有（17/18）没有肺癌的患者都有来自其他原发性癌症的肺转移。干咳患者报告称从帕罗西汀中获益更大。在56%（19/34）的无痰干咳患者中，80%（15/19）报告在服用帕罗西汀后症状有所改善。其余15名患者，占该组的44%，表现为有痰的胸部咳嗽（9/34，27%）或混合性咳嗽（6/34，18%）。在这些患者中，60%（9/15）报告症状有所改善。三分之二的患者开始服用10毫克帕罗西汀（22/34，65%），其余患者开始服用20毫克（14/34，35%）。
帕罗西汀可能是治疗晚期癌症患者顽固性和持续性咳嗽的一种有效、新型的超说明书用药治疗方法。
