Watanabe Daichi, Iihara Hirotoshi, Kobayashi Ryo, Fujii Hironori, Mori Ryutaro, Kumada Keisuke, Shimizu Masahito, Futamura Manabu, Suzuki Akio
Department of Pharmacy, Gifu University Hospital, Gifu, Japan.
Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, Japan.
Front Oncol. 2024 Jul 26;14:1414037. doi: 10.3389/fonc.2024.1414037. eCollection 2024.
The effectiveness of a dexamethasone-sparing strategy in the treatment of breast cancer with anthracycline-cyclophosphamide therapy when combined with first-generation 5-HT3 receptor antagonists (RAs) and neurokinin-1 RAs is unclear. This is attributable to a lack of evidence from direct comparison of multiple doses of DEX to a single dose of DEX in combination with first-generation 5-HT3 RAs in anthracycline-cyclophosphamide therapy. Our goal was to clarify the impact of dexamethasone-sparing strategies that involve both first-generation 5-HT3 RAs and palonosetron when combined with neurokinin-1 RAs, using a network meta-analysis.
A literature search was conducted on PubMed/Medline for articles published up to July 4, 2023. We included randomized controlled trials which assessed the efficacy of antiemetic regimens which combined 5-HT3 RAs and dexamethasone, with or without neurokinin-1 RAs, for the initial dose in anthracycline-cyclophosphamide therapy for patients with breast cancer. The primary outcome was the proportion of patients achieving a complete response during the delayed phase (CR-DP).
The difference in the proportion of patients achieving CR-DP between multiple and single doses of dexamethasone was 0.1% (95%CI: -12.4 to 12.5) with palonosetron and neurokinin-1 RAs, compared to 5.3% (95%CI: -13.4 to 23.0) with a single dose of a first-generation 5-HT3 receptor antagonist. Additionally, the difference was 12.7% (95% CI: -2.8 to 28.2) when comparing palonosetron against first-generation 5-HT3 RAs in combination with a single dose of dexamethasone and neurokinin-1 RAs.
Palonosetron is recommended rather than a single dose of first-generation 5-HT3 RAs in dexamethasone-sparing strategies for anthracycline-cyclophosphamide therapy.
在蒽环类药物-环磷酰胺治疗乳腺癌时，地塞米松减量策略联合第一代5-羟色胺3受体拮抗剂（RAs）和神经激肽-1 RAs的有效性尚不清楚。这是由于缺乏在蒽环类药物-环磷酰胺治疗中，多剂量地塞米松与单剂量地塞米松联合第一代5-羟色胺3 RAs直接比较的证据。我们的目标是通过网络荟萃分析，阐明涉及第一代5-羟色胺3 RAs和帕洛诺司琼并联合神经激肽-1 RAs的地塞米松减量策略的影响。
在PubMed/Medline上检索截至2023年7月4日发表的文章。我们纳入了随机对照试验，这些试验评估了在乳腺癌患者的蒽环类药物-环磷酰胺治疗初始剂量中，联合或不联合神经激肽-1 RAs的5-羟色胺3 RAs和地塞米松的止吐方案的疗效。主要结局是在延迟期达到完全缓解（CR-DP）的患者比例。
与单剂量第一代5-羟色胺3受体拮抗剂相比，帕洛诺司琼和神经激肽-1 RAs存在时，多剂量与单剂量地塞米松之间达到CR-DP的患者比例差异为0.1%（95%CI：-12.4至12.5），而单剂量第一代5-羟色胺3受体拮抗剂时为5.3%（95%CI：-13.4至23.0）。此外，在比较帕洛诺司琼与联合单剂量地塞米松和神经激肽-1 RAs的第一代5-羟色胺3 RAs时，差异为12.7%（95%CI：-2.8至28.2）。
在蒽环类药物-环磷酰胺治疗的地塞米松减量策略中，推荐使用帕洛诺司琼而非单剂量第一代5-羟色胺3 RAs。
