Department of Hematology and Oncology, University of Halle-Wittenberg, Halle (Saale); Charité Center for ambulant health, Department of Hematology, Oncology and Tumor Immunology, Charité University Medicine, Campus Virchow, Berlin; Department of Hematology, Oncology, and Rheumatology, Heidelberg University Hospital; Pharmacy and Patient Advice Center, Universitätsmedizin Marburg-Campus Fulda; Berliner Krebsgesellschaft e. V., Berlin; Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam.
Dtsch Arztebl Int. 2022 May 27;119(21):382-392. doi: 10.3238/arztebl.m2022.0093.
Nausea and vomiting are common and distressing side effects of tumor therapy. Despite prophylaxis, 40-50% of patients suffer from nausea, and 20-30% from vomiting. Antiemetic prophylaxis and treatment are therefore of great importance for improving patients' quality of life and preventing sequelae such as tumor cachexia.
The recommendations presented here are based on international and national guidelines, updated with publications retrieved by a selective search in the PubMed and Cochrane Library databases, with special attention to randomized controlled trials and meta-analyses that have appeared in the past 5 years since the German clinical practice guideline on supportive therapy was published.
Risk-adjusted prevention and treatment is based on the identification of treatment-related and patient-specific risk factors, including female sex and younger age. Parenteral tumor therapy is divided into four risk classes (minimal, low, moderate, high), and oral tumor therapy into two (minimal/low, moderate/high). In radiotherapy, the radiation field is of decisive importance. The antiemetic drugs most commonly used are 5-HT3-RA, NK1-RA, and dexamethasone; olanzapine has proven beneficial as an add-on or rescue drug. The use of steroids in patients being treated with drug combinations including checkpoint inhibitors is discussed controversially because of the potentially reduced therapeutic response. Benzodiazepines, dimenhydrinate, and cannabinoids can be used as backup antiemetics. Acupuncture/acupressure, ginger, and progressive muscle relaxation are pos - sible alternative methods.
Detailed, effective, risk profile-adapted algorithms for the prevention and treatment of nausea and vomiting are now available for patients undergoing classic chemotherapy regimens or combined radiotherapy and chemotherapy. Optimal symptom control for patients undergoing oral tumor therapy over multiple days in the outpatient setting remains a challenge.
恶心和呕吐是肿瘤治疗常见且令人痛苦的副作用。尽管进行了预防，仍有 40-50%的患者出现恶心，20-30%的患者出现呕吐。因此，止吐预防和治疗对于提高患者的生活质量和预防肿瘤恶病质等后遗症非常重要。
本建议基于国际和国家指南，结合在 PubMed 和 Cochrane Library 数据库中进行选择性搜索获得的文献进行更新，特别关注自德国支持治疗临床实践指南发布以来过去 5 年出现的随机对照试验和荟萃分析。
基于治疗相关和患者特定风险因素（包括女性和年轻）的风险调整预防和治疗。静脉内肿瘤治疗分为四个风险等级（最小、低、中、高），口服肿瘤治疗分为两个等级（最小/低、中/高）。在放射治疗中，放射野是决定性的。最常用的止吐药物是 5-HT3-RA、NK1-RA 和地塞米松；奥氮平已被证明作为附加或抢救药物有益。由于潜在的治疗反应降低，在包括检查点抑制剂在内的药物联合治疗中使用皮质类固醇存在争议。苯二氮䓬类、茶苯海明和大麻素可用作备用止吐药。针刺/穴位按压、生姜和渐进性肌肉松弛是可能的替代方法。
现在有详细、有效的、适应风险特征的预防和治疗恶心和呕吐的算法，适用于接受经典化疗方案或联合放化疗的患者。在门诊环境中，为接受多日口服肿瘤治疗的患者提供最佳症状控制仍然是一个挑战。
