Department of Pharmacy, Gifu University Hospital, Gifu, Japan.
Laboratory of Pharmacy Practice and Social Science, Gifu Pharmaceutical University, Gifu, Japan.
Oncologist. 2020 Feb;25(2):e373-e380. doi: 10.1634/theoncologist.2019-0292. Epub 2019 Oct 21.
We previously reported the results of a prospective study of chemotherapy-induced nausea and vomiting (CINV) in a cohort of patients who received carboplatin-based chemotherapy and were selected from a nationwide registry of those scheduled for moderately (MEC) or highly emetogenic chemotherapy (HEC) by the CINV Study Group of Japan. Of 1,910 previously registered patients (HEC: 1,195; MEC: 715), 400 patients received carboplatin-based chemotherapy. The frequency of CINV was determined, and the risk factors for CINV were assessed.
CINV data were collected from 7-day diaries. Risk factors for CINV were identified using logistic regression models.
Of 400 patients scheduled for carboplatin-based chemotherapy, 267 patients received two antiemetics (5-hydroxytryptamine-3 receptor antagonist [5-HT RA] and dexamethasone [DEX]), 118 patients received three antiemetics (5-HT RA, DEX, and neurokinin-1 receptor antagonist [NK RA]), and 15 were nonadherent to the treatment. In these patients, the CINV overall, acute, and delayed phase rates of complete response (CR), defined as no vomiting with no rescue medication, were 67.0%, 98.2%, and 67.5%, respectively. The rates of no nausea were 55.6%, 94.0%, and 56.1%, respectively, and those of no vomiting were 81.3%, 99.0%, and 81.8%, respectively. Older age was associated with a decreased non-CR, whereas female sex, history of pregnancy-related emesis, and dual antiemetic therapy were associated with an increased non-CR during the overall period.
In a clinical practice setting, in patients who received carboplatin-based chemotherapy, adherence is quite high and appropriate antiemetic prophylaxis requires a triple antiemetic regimen including NK RA.
For patients receiving carboplatin-based chemotherapy, triple antiemetic therapy with 5-hydroxytryptamine-3 receptor antagonist, dexamethasone, and neurokinin-1 receptor antagonist should be given prophylactically regardless of risk factor status.
我们曾报道过一项接受卡铂为基础化疗的患者前瞻性恶心呕吐（CINV）研究结果，该研究患者队列选自日本 CINV 研究组全国注册登记的中度（MEC）或高度致吐性化疗（HEC）患者。在之前登记的 1910 名患者中（HEC：1195 例；MEC：715 例），400 例接受了卡铂为基础化疗。我们确定了 CINV 的发生频率，并评估了 CINV 的危险因素。
通过 7 天日记收集 CINV 数据。使用 logistic 回归模型确定 CINV 的危险因素。
在计划接受卡铂为基础化疗的 400 例患者中，267 例患者接受了两种止吐药（5-羟色胺 3 受体拮抗剂[5-HT RA]和地塞米松[DEX]），118 例患者接受了三种止吐药（5-HT RA、DEX 和神经激肽 1 受体拮抗剂[NK RA]），15 例患者未按治疗方案用药。在这些患者中，完全缓解（CR）的 CINV 总发生率、急性期和延迟期发生率分别为 67.0%、98.2%和 67.5%。无恶心发生率分别为 55.6%、94.0%和 56.1%，无呕吐发生率分别为 81.3%、99.0%和 81.8%。年龄较大与非 CR 降低相关，而女性、妊娠相关呕吐史和双重止吐治疗与总期间非 CR 增加相关。
在临床实践中，接受卡铂为基础化疗的患者，其依从性相当高，适当的止吐预防需要包括 NK RA 的三联止吐方案。
对于接受卡铂为基础化疗的患者，无论危险因素状况如何，都应预防性给予三联止吐治疗，包括 5-羟色胺 3 受体拮抗剂、地塞米松和神经激肽 1 受体拮抗剂。
