在预防卡铂引起的恶心和呕吐方面，向 5 毫克奥氮平、5-羟色胺 3 受体拮抗剂和地塞米松中添加神经激肽-1 受体拮抗剂的效果：倾向评分匹配分析。
Effects of adding a neurokinin-1 receptor antagonist to 5 mg olanzapine, a 5-hydroxytryptamine-3 receptor antagonist, and dexamethasone for preventing carboplatin-induced nausea and vomiting: a propensity score-matched analysis.
机构信息
Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
Laboratory of Pharmacy Practice and Social Science, Gifu Pharmaceutical University, 1-25-4 Daigakunishi, Gifu, 501-1196, Japan.
出版信息
BMC Cancer. 2022 Mar 23;22(1):310. doi: 10.1186/s12885-022-09392-9.
BACKGROUND
Olanzapine has been reported to be an effective antiemetic in patients receiving carboplatin-based chemotherapy. However, the efficacy of a neurokinin-1 receptor antagonist (NKRA) added to olanzapine, a 5-hydroxytryptamine-3 receptor antagonist (5-HTRA), and dexamethasone (DEX) has not been proven. This study aimed to assess the efficacy and safety of NKRA, in combination with three-drug antiemetic regimens containing olanzapine, in preventing nausea and vomiting induced by carboplatin-based chemotherapy.
METHODS
Data were pooled for 140 patients receiving carboplatin-based chemotherapy from three multicenter, prospective, single-arm, open-label phase II studies that evaluated the efficacy and safety of olanzapine for chemotherapy-induced nausea and vomiting. The propensity score of the co-administration of NKRA was estimated for each patient using a logistic regression model that included age, sex, and carboplatin dose. We analyzed a total of 62 patients, who were treated without NKRA (non-NKRA group: 31 patients) and with NKRA (NKRA group: 31 patients). The patients were selected using propensity score matching.
RESULTS
The complete response rate (without emetic episodes or with no administration of rescue medication) in the overall period (0-120 h post carboplatin administration) was 93.5% in the non-NKRA group and 96.8% in the NKRA group, with a difference of -3.2% (95% confidence interval, -18.7% to 10.9%; P = 1.000). In terms of safety, there was no significant difference between the groups in daytime sleepiness and concentration impairment, which are the most worrisome adverse events induced by olanzapine.
CONCLUSIONS
The findings suggest that antiemetic regimens consisting of olanzapine, 5HTRA, and DEX without NKRA may be a treatment option for patients receiving carboplatin-based chemotherapy.
背景
奥氮平已被报道在接受顺铂为基础的化疗的患者中是一种有效的止吐药。然而，神经激肽-1 受体拮抗剂（NKRA）与奥氮平、5-羟色胺-3 受体拮抗剂（5-HTRA）和地塞米松（DEX）联合使用的疗效尚未得到证实。本研究旨在评估 NKRA 联合奥氮平、5-HTRA 和 DEX 的三联止吐方案预防顺铂为基础的化疗引起的恶心和呕吐的疗效和安全性。
方法
对三项多中心、前瞻性、单臂、开放标签的 II 期研究中接受顺铂为基础的化疗的 140 例患者的数据进行了汇总，这些研究评估了奥氮平预防化疗引起的恶心和呕吐的疗效和安全性。采用逻辑回归模型，对每个患者联合使用 NKRA 的倾向评分进行了估计，该模型纳入了年龄、性别和卡铂剂量。我们共分析了 62 例患者，他们未接受 NKRA 治疗（非 NKRA 组：31 例）和接受 NKRA 治疗（NKRA 组：31 例）。患者采用倾向评分匹配选择。
结果
非 NKRA 组在整个时期（卡铂给药后 0-120 小时）的完全缓解率（无呕吐发作或无需使用解救药物）为 93.5%，NKRA 组为 96.8%，差异为-3.2%（95%置信区间，-18.7%至 10.9%；P=1.000）。在安全性方面，两组在日间嗜睡和注意力障碍方面无显著差异，这是奥氮平最令人担忧的不良事件。
结论
这些发现表明，不含 NKRA 的奥氮平、5-HTRA 和 DEX 止吐方案可能是接受顺铂为基础的化疗的患者的一种治疗选择。
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