Department of Pharmacy, Hokkaido University Hospital.
Department of Clinical Pharmaceutics & Therapeutics, Faculty of Pharmaceutical Sciences, Hokkaido University of Science.
Biol Pharm Bull. 2024;47(6):1189-1195. doi: 10.1248/bpb.b24-00046.
Although carboplatin (CBDCA) is classified as a moderately emetogenic agent, the majority of guidelines recommend the use of a neurokinin-1 receptor antagonist in addition to a 5-hydroxytryptamine type 3 receptor antagonist with dexamethasone (DEX) for CBDCA-containing chemotherapy because of its higher emetogenic risk. However, the additional efficacy of aprepitant (APR) in CBDCA-containing treatment remains controversial, and data on multiple-day treatments are limited. Etoposide (ETP) was administered on days 1-3 in the CBDCA + ETP regimen, and it is important to evaluate suitable antiemetic therapy for the regimen. Therefore, we evaluated the efficacy of additional APR in CBDCA + ETP. Patients were divided into two groups and retrospectively evaluated. One was the control group, which was prophylactically administered palonosetron (PALO) and DEX, and the other was the APR group, which received APR orally with PALO and DEX. The primary endpoint was complete response (CR) between the groups. The overall CR rates were 75.0 and 76.4% in the control and APR groups, respectively, with no significant difference (p = 1.00). In the acute phase, it was 88.9 and 97.2%, respectively, and 86.1 and 79.2% in the delayed phase, respectively, without significant differences (p = 0.10 and 0.38, respectively). The incidence and severity of nausea, vomiting, and anorexia were not significantly different between the two groups in the acute and delayed phases. Our findings suggest that combining APR with PALO and DEX does not improve the CR rate in CBDCA + ETP therapy.
虽然卡铂（CBDCA）被归类为中度致吐药物，但由于其更高的致吐风险，大多数指南建议在含 CBDCA 的化疗中除了使用 5-羟色胺 3 型受体拮抗剂和地塞米松（DEX）外，还使用神经激肽-1 受体拮抗剂。然而，阿瑞匹坦（APR）在含 CBDCA 治疗中的额外疗效仍存在争议，且关于多日治疗的数据有限。依托泊苷（ETP）在 CBDCA+ETP 方案中第 1-3 天给药，因此评估该方案合适的止吐治疗非常重要。因此，我们评估了在 CBDCA+ETP 中添加 APR 的疗效。患者分为两组进行回顾性评估。一组为对照组，预防性给予帕洛诺司琼（PALO）和 DEX；另一组为 APR 组，口服 APR 联合 PALO 和 DEX。主要终点是两组之间的完全缓解（CR）。对照组和 APR 组的总 CR 率分别为 75.0%和 76.4%，差异无统计学意义（p=1.00）。在急性期，分别为 88.9%和 97.2%，在迟发性阶段，分别为 86.1%和 79.2%，差异无统计学意义（p=0.10 和 0.38，分别）。在急性期和迟发性阶段，两组恶心、呕吐和厌食的发生率和严重程度差异无统计学意义。我们的研究结果表明，在 CBDCA+ETP 治疗中，APR 联合 PALO 和 DEX 并不能提高 CR 率。
