Notini Giulia, Naldini Matteo Maria, Sica Lorenzo, Viale Giulia, Rognone Alessia, Zambelli Stefania, Zucchinelli Patrizia, Piras Marta, Bosi Carlo, Mariani Marco, Aldrighetti Daniela, Bianchini Giampaolo, Licata Luca
Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
School of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy.
Front Oncol. 2024 Mar 11;14:1374547. doi: 10.3389/fonc.2024.1374547. eCollection 2024.
Nausea and vomiting are common side effects of Trastuzumab Deruxtecan (T-DXd), but guidelines for optimal management were not initially available. This retrospective single-center study aimed at evaluating the efficacy of two antiemetic regimens in patients receiving T-DXd.
Data from metastatic breast cancer patients receiving T-DXd were collected. Two groups were defined: patients treated with 5-HT3 receptor antagonists (RA) ± dexamethasone (5-HT3-group) and patients treated with a fixed oral combination of netupitant (NK1RA) and palonosetron ± dexamethasone (NK1 group). Physicians preferentially offered the NK1 regimen to patients at higher risk of nausea and vomiting based on internal recommendations. Only nausea and vomiting during cycles 1 and 2 were considered. Comparisons of nausea and vomiting by the antiemetic prophylaxis group were assessed using chi-square.
A total of 53 patients were included in the analysis. At cycle 1, 72% and 28% of patients received the 5-HT3 and NK1 prophylaxis, respectively. Overall, 58% reported nausea, with no differences between groups (58% vs. 60%; = 0.832), but with a trend for lower grade in the NK1 group (33.3% G1; 26.7% G2) compared to the 5-HT3 group (23.7% G1; 31.6% G2; 2.6% G3). Vomiting was reported by 21% and 0% of patients in the 5-HT3 and the NK1 group, respectively ( = 0.054). Among the 15 patients in the 5-HT3 group with nausea at cycle 1 who escalated to NK1 at cycle 2, nausea decreased from 100% to 53% ( = 0.022) and vomiting decreased from 47% to 13% ( = 0.046).
The NK1 regimen improved vomiting control at cycle 1 and, when introduced at cycle 2, significantly improved both nausea and vomiting. The biased NK1 selection for higher-risk patients may have dampened the differences between groups at cycle 1. These findings support enhanced control of T-DXd-related nausea and vomiting with NK1RA.
恶心和呕吐是曲妥珠单抗德鲁替康（T-DXd）常见的副作用，但最初尚无最佳管理指南。这项回顾性单中心研究旨在评估两种止吐方案在接受T-DXd治疗患者中的疗效。
收集接受T-DXd治疗的转移性乳腺癌患者的数据。定义了两组：接受5-羟色胺3受体拮抗剂（RA）±地塞米松治疗的患者（5-羟色胺3组）和接受奈妥匹坦（NK1RA）与帕洛诺司琼±地塞米松固定口服联合治疗的患者（NK1组）。根据内部建议，医生优先为恶心和呕吐风险较高的患者提供NK1方案。仅考虑第1和第2周期的恶心和呕吐情况。使用卡方检验评估止吐预防组之间恶心和呕吐的比较。
共有53例患者纳入分析。在第1周期，分别有72%和28%的患者接受了5-羟色胺3和NK1预防。总体而言，58%的患者报告有恶心，两组之间无差异（58%对60%；P = 0.832），但与5-羟色胺3组（23.7%为1级；31.6%为2级；2.6%为3级）相比，NK1组恶心程度较低（33.3%为1级；26.7%为2级）。5-羟色胺3组和NK1组分别有21%和0%的患者报告有呕吐（P = 0.054）。在第1周期恶心且在第2周期升级为NK1方案的5-羟色胺3组的15例患者中，恶心从100%降至53%（P = 0.022），呕吐从47%降至13%（P = 0.046）。
NK1方案在第1周期改善了呕吐控制，并且在第2周期采用时，显著改善了恶心和呕吐情况。对高风险患者偏向选择NK1方案可能掩盖了第1周期两组之间的差异。这些发现支持使用NK1RA加强对T-DXd相关恶心和呕吐的控制。
