在接受铂类化疗的肺癌患者中使用地塞米松和5-羟色胺3（5-HT3）受体拮抗剂（联合或不联合阿瑞匹坦）预防化疗引起的恶心和呕吐：一项随机对照试验的系统评价和荟萃分析
Use of dexamethasone and a 5-HT3 receptor antagonist with or without aprepitant to prevent chemotherapy-induced nausea and vomiting among patients with lung cancer who are treated with platinum-based chemotherapy: a systematic review and meta-analysis of randomized controlled trials.
作者信息
He Mengyu, Xu Ruoxin, Liu Miaowen, Zhang Yixuan, Yi Fengming, Wei Yiping, Liu Qing, Zhang Wenxiong
机构信息
Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China; Jiangxi Medical College, Nanchang University, Nanchang, China.
Jiangxi Medical College, Nanchang University, Nanchang, China.
出版信息
Ann Palliat Med. 2021 Apr;10(4):4308-4319. doi: 10.21037/apm-20-2290. Epub 2021 Apr 15.
BACKGROUND
Researchers have not clearly determined whether adding aprepitant (ADH) to dexamethasone and one 5-HT3 receptor antagonist (DH) is clinically effective at preventing chemotherapy-induced nausea and vomiting (CINV) among patients with lung cancer (LC) treated with platinum-based chemotherapy (PBC). Therefore, we conducted a meta-analysis to examine the efficacy and safety of ADH and DH.
METHODS
We searched the PubMed, ScienceDirect, Cochrane Library, and Scopus databases, among others, for relevant studies. The primary outcomes were the complete response (CR) and the no nausea rate (NNR). The secondary endpoints were the number of patients who needed rescue antiemetic treatment (RAT), adverse events (AEs), and the Functional Living Index Emesis (FLIE) score.
RESULTS
We initially screened 2,118 articles; ultimately, four randomized controlled trials (RCTs) with 518 patients were included. The ADH group had a superior overall CR [risk ratio (RR): 1.16 (1.06, 1.27), P=0.002] and a lower number of patients who needed RAT [RR: 0.44 (0.29, 0.65), P<0.0001]. The ADH group also had a better overall NNR [RR: 1.11 (0.97, 1.26), P=0.12] and delayed CR [RR: 1.12 (0.97, 1.31), P=0.13]. No significant differences were observed in acute CR, acute NNR, or delayed NNR. In the subgroup analysis of the overall CR and NNR, ADH was superior in certain clinical characteristics (China, cisplatin-based chemotherapy, 2nd-generation 5-HT3 receptor antagonist, ADC <50%, and Eastern Cooperative Oncology Group (ECOG) score of 0-2). No significant differences in the AEs characterized as hematological or nonhematological toxicity were observed between the groups.
CONCLUSIONS
Compared with DH, ADH appears to be superior at preventing CINV and achieving a better CR among patients with LC treated with PBC.
背景
对于接受铂类化疗（PBC）的肺癌（LC）患者，在使用地塞米松和一种5 - 羟色胺3型受体拮抗剂（DH）的基础上加用阿瑞匹坦（ADH）预防化疗引起的恶心和呕吐（CINV）是否具有临床疗效，研究人员尚未明确确定。因此，我们进行了一项荟萃分析以检验ADH和DH的疗效及安全性。
方法
我们检索了PubMed、ScienceDirect、Cochrane图书馆和Scopus数据库等以查找相关研究。主要结局为完全缓解（CR）和无恶心率（NNR）。次要终点为需要急救性止吐治疗（RAT）的患者数量、不良事件（AE）以及功能性生活指数呕吐（FLIE）评分。
结果
我们最初筛选了2118篇文章；最终纳入了4项随机对照试验（RCT），共518例患者。ADH组的总体CR更佳[风险比（RR）：1.16（1.06，1.27），P = 0.002]，且需要RAT的患者数量更少[RR：0.44（0.29，0.65），P < 0.0001]。ADH组的总体NNR也更好[RR：1.11（0.97，1.26），P = 0.12]，延迟CR也更佳[RR：1.12（0.97，1.31），P = 0.13]。在急性CR、急性NNR或延迟NNR方面未观察到显著差异。在总体CR和NNR的亚组分析中，ADH在某些临床特征（中国、基于顺铂的化疗、第二代5 - 羟色胺3型受体拮抗剂、ADC < 50%以及东部肿瘤协作组（ECOG）评分为0 - 2）方面更具优势。两组之间在以血液学或非血液学毒性为特征的AE方面未观察到显著差异。
结论
与DH相比，ADH在预防接受PBC治疗的LC患者的CINV及实现更好的CR方面似乎更具优势。
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