一项关于接受 AUC≥4 卡铂或联合蒽环类药物-环磷酰胺治疗的患者使用预防止吐药和 CINV 发生率的前瞻性审核。
A prospective audit on the use of prophylactic antiemetics and rates of CINV in patients receiving carboplatin AUC≥4 or combination anthracycline-cyclophosphamide.
机构信息
Phase 1/Lung Research Fellow, Auckland Cancer Trials Centre, Auckland District Health Board.
Regional Cancer Treatment Service, MidCentral District Health Board.
出版信息
N Z Med J. 2021 Apr 16;134(1533):33-45.
BACKGROUND
Chemotherapy-induced nausea and vomiting (CINV) are two of the most frequently experienced and distressing side effects of cancer treatment. Recent updates by ESMO/MASCC and ASCO on guidelines for prevention of CINV have recommended the addition of a neurokinin-1 receptor antagonist to antiemetic regimens for patients receiving carboplatin-based chemotherapy area under the curve (AUC) ≥4 mg/mL per minute, and an addition of olanzapine for those receiving combination anthracycline/cyclophosphamide chemotherapy.
AIMS
To assess current use of prophylactic antiemetics and rates of CINV in patients under the care of MidCentral Regional Cancer Treatment Service (MRCTS) receiving carboplatin AUC≥4 or combination anthracycline/cyclophosphamide.
METHODS
Data was prospectively collected on patients under the care of MRCTS receiving carboplatin AUC≥4 or combination anthracycline/cyclophosphamide chemotherapy, including breast cancer patients receiving 5-fluorouracil, epirubicin and cyclophosphamide (FEC) and lymphoma patients receiving rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP). Questionnaires were given to eligible patients to be completed daily from day two to day six of first cycle of chemotherapy only. Data on each patient's gender, age, types of chemotherapies, types of malignancies, presence of nausea or vomiting, number of dry retching or vomiting episodes and anti-emetics were recorded.
RESULTS
From 15 September 2018 to 10 August 2019, a total of 44 patients receiving carboplatin-based chemotherapy AUC≥4 and 30 patients receiving combination anthracycline/cyclophosphamide were included. Twenty-two patients (50%) had either emesis or significant nausea in the overall and delayed phase when treated with carboplatin AUC≥4, and only three (7%) in the acute phase. Fourteen patients (56%) had either emesis or significant nausea in the overall phase when treated with FEC chemotherapy, mostly in the acute phase (13 patients) rather than in the delayed phase (9 patients).
CONCLUSION
The rates of CINV are high with the existing antiemetic regimens used at MidCentral Regional Cancer Treatment Service. Therefore, in accordance with international guidelines, we will add a neurokinin-1 antagonist to the antiemetic regimens for patients receiving carboplatin-based chemotherapy AUC≥4, and olanzapine for those receiving combination anthracycline/cyclophosphamide chemotherapy, in an attempt to improve the rates of CINV in these groups. Repeating this audit post-implementation of above recommendations will be important to assess for any improvement.
背景
化疗引起的恶心和呕吐（CINV）是癌症治疗中最常经历和最痛苦的副作用之一。ESMO/MASCC 和 ASCO 最近更新的 CINV 预防指南建议，对于接受基于卡铂的化疗曲线下面积（AUC）≥4mg/mL/分钟的患者，在止吐方案中添加神经激肽-1 受体拮抗剂，并对接受蒽环类药物/环磷酰胺联合化疗的患者添加奥氮平。
目的
评估 MidCentral 地区癌症治疗服务（MRCTS）接受卡铂 AUC≥4 或联合蒽环类药物/环磷酰胺化疗的患者中预防性止吐药物的使用情况和 CINV 发生率。
方法
前瞻性收集接受卡铂 AUC≥4 或联合蒽环类药物/环磷酰胺化疗的 MRCTS 患者的数据，包括接受氟尿嘧啶、表柔比星和环磷酰胺（FEC）的乳腺癌患者和接受利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）的淋巴瘤患者。仅在化疗第一周期的第 2 至第 6 天向符合条件的患者发放问卷进行每日填写。记录每位患者的性别、年龄、化疗类型、恶性肿瘤类型、恶心或呕吐的存在、干呕或呕吐发作次数和止吐药物。
结果
从 2018 年 9 月 15 日至 2019 年 8 月 10 日，共纳入 44 例接受卡铂为基础的 AUC≥4 化疗的患者和 30 例接受联合蒽环类药物/环磷酰胺化疗的患者。22 例（50%）在接受卡铂 AUC≥4 治疗时在总体和迟发性阶段出现呕吐或明显恶心，仅 3 例（7%）在急性阶段出现。14 例（56%）在接受 FEC 化疗时在总体阶段出现呕吐或明显恶心，主要发生在急性阶段（13 例）而非迟发性阶段（9 例）。
结论
目前在 MidCentral 地区癌症治疗服务中使用的止吐方案，CINV 的发生率较高。因此，根据国际指南，我们将为接受卡铂为基础的 AUC≥4 化疗的患者添加神经激肽-1 拮抗剂，为接受蒽环类药物/环磷酰胺联合化疗的患者添加奥氮平，以提高这些患者的 CINV 发生率。在实施上述建议后，重复这项审计以评估任何改善是很重要的。
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