Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, 8-19-1, Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
Department of Biostatistics, Yamaguchi University Graduate School of Medicine, 1-1-1, Minami Kogushi, Ube, 755-8505, Yamaguchi, Japan.
Support Care Cancer. 2021 Sep;29(9):5029-5035. doi: 10.1007/s00520-021-06061-8. Epub 2021 Feb 16.
Dexamethasone (DEX)-sparing strategies (one-day DEX) with palonosetron as doublet antiemetic prophylaxis have previously been studied. However, DEX-sparing regimens with 5-hydroxytryptamine-3 receptor antagonist (5-HTRA) and aprepitant (APR), as triplet antiemetic prophylaxis, have not been evaluated. This study aimed to evaluate the efficacy of a combination of 5-HTRA, APR, and DEX on day 1 of carboplatin (CBDCA)-based chemotherapy in patients with lung cancer.
Data were pooled from a nationwide, multicenter, prospective observational study using propensity score-matched analysis to compare the incidence of chemotherapy-induced nausea and vomiting (CINV) between one- and multiple-day DEX regimens in combination with 5-HTRA plus APR.
Incidence of delayed nausea was significantly higher in the one-day than in the multiple-day DEX group. Incidence of nausea was also significantly higher in the one-day than in the multiple-day DEX group on days 3-5. Kaplan-Meier curves for nausea showed a significant difference between the two groups; however, there was no significant difference in the occurrence of vomiting or the Kaplan-Meier curves of time to vomiting.
To the best of our knowledge, this study is the first to evaluate the efficacy of a DEX-sparing regimen by comparing one- and multiple-day DEX combined with 5-HTRA and APR concerning CINV incidence in lung cancer patients receiving CBDCA-based chemotherapy. Antiemetic regimens of one-day DEX result in poor control of delayed nausea; therefore, we recommend the application of the DEX-sparing strategy only after careful patient selection while considering the development of nausea.
先前已经研究过含帕洛诺司琼的地塞米松（DEX）节省方案（一日 DEX）作为双联止吐预防方案。然而，作为三联止吐预防方案的 5-羟色胺 3 受体拮抗剂（5-HTRA）和阿瑞匹坦（APR）与 DEX 联合的 DEX 节省方案尚未得到评估。本研究旨在评估 5-HTRA、APR 和 DEX 联合方案在基于卡铂（CBDCA）的化疗第 1 天对肺癌患者的疗效。
使用倾向评分匹配分析，对一项全国性、多中心、前瞻性观察性研究的数据进行汇总，以比较 5-HTRA 联合 APR 与 1 日和多日 DEX 方案联合方案在预防化疗引起的恶心和呕吐（CINV）方面的疗效。
1 日 DEX 组迟发性恶心的发生率明显高于多日 DEX 组。3-5 天，1 日 DEX 组恶心的发生率也明显高于多日 DEX 组。两组恶心的 Kaplan-Meier 曲线存在显著差异；然而，呕吐的发生或呕吐时间的 Kaplan-Meier 曲线没有显著差异。
据我们所知，这项研究首次通过比较含 5-HTRA 和 APR 的 1 日和多日 DEX 方案在接受 CBDCA 为基础的化疗的肺癌患者中的 CINV 发生率，评估了 DEX 节省方案的疗效。1 日 DEX 止吐方案在控制迟发性恶心方面效果不佳；因此，我们建议仅在仔细选择患者并考虑恶心发展的情况下应用 DEX 节省策略。
