Department of Early Clinical Development, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
Faculty of Medicine, Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University, 89-1 Enya-Cho, Izumo, Shimane, 693-8501, Japan.
Int J Clin Oncol. 2024 Nov;29(11):1632-1640. doi: 10.1007/s10147-024-02624-x. Epub 2024 Sep 28.
Chemotherapy-induced nausea and vomiting (CINV) are common side effects, classified according to timing and severity. Conventional agents such as dexamethasone are effective but have various side effects. For moderately emetogenic chemotherapy, dexamethasone-sparing antiemetic therapies have been developed to minimize these side effects. This systematic review evaluated the efficacy and safety of dexamethasone-sparing antiemetic therapy for highly emetogenic chemotherapy (HEC).
We performed a thorough literature search for studies related to dexamethasone-sparing antiemetic therapy with neurokinin-1 antagonists (NKRA) for HEC using the PubMed, Cochrane Library, and Ichushi-Web databases. A qualitative analysis of the combined data was performed and risk differences with confidence intervals were calculated.
Two reviewers independently assessed the 425 records and 12 full-text articles were evaluated for eligibility. Two studies were included in the qualitative and meta-analyses. These studies included anthracycline-cyclophosphamide (AC) regimens and cisplatin-based regimens, with palonosetron as the serotonin receptor antagonist. In the two studies, no difference was found in the prevention of vomiting (delayed complete response). However, non-inferiority was not demonstrated in the subgroup that received cisplatin-containing regimens. Delayed complete control showed different results for nausea prevention; however, there was no significant difference in the meta-analysis. Only one report has shown non-inferiority for delayed total control. Although the strength of evidence for individual outcomes varied, there was no difference in the duration of dexamethasone administration.
This systematic review and meta-analysis revealed that dexamethasone-sparing antiemetic therapy with NKRA and palonosetron can be used to prevent CINV in HEC, limited to AC combination therapy.
化疗引起的恶心和呕吐（CINV）是常见的副作用，根据时间和严重程度进行分类。地塞米松等常规药物虽然有效，但有各种副作用。对于中度致吐性化疗，已经开发了地塞米松节约型止吐治疗方法，以最大限度地减少这些副作用。本系统评价评估了神经激肽-1 拮抗剂（NKRA）联合地塞米松节约型止吐治疗高度致吐性化疗（HEC）的疗效和安全性。
我们使用 PubMed、Cochrane 图书馆和 Ichushi-Web 数据库，对与 NKRA 联合地塞米松节约型止吐治疗 HEC 的相关研究进行了全面的文献检索。对合并数据进行定性分析，并计算风险差异和置信区间。
两名审查员独立评估了 425 条记录，评估了 12 篇全文文章的纳入资格。两项研究纳入了定性和荟萃分析。这些研究包括蒽环类药物-环磷酰胺（AC）方案和顺铂为基础的方案，5-羟色胺受体拮抗剂为帕洛诺司琼。在这两项研究中，预防呕吐（延迟完全缓解）方面没有差异。然而，在接受含顺铂方案的亚组中，未证明非劣效性。延迟完全控制在预防恶心方面显示出不同的结果；然而，荟萃分析没有显示出统计学差异。只有一份报告显示延迟总控制具有非劣效性。尽管个别结局的证据强度不同，但地塞米松给药时间没有差异。
本系统评价和荟萃分析表明，NKRA 和帕洛诺司琼联合地塞米松节约型止吐治疗可用于预防 HEC 的 CINV，仅限于 AC 联合治疗。
