Del Favero A, Roila F, Tonato M
Institute of Internal Medicine I, University of Perugia, Italy.
Drug Saf. 1993 Dec;9(6):410-28. doi: 10.2165/00002018-199309060-00004.
Nausea and vomiting are among the most distressing adverse effects of cancer chemotherapy. In the last 10 years considerable advances in the prevention of chemotherapy-induced emesis have been made. From an analysis of the results obtained in patients receiving moderately- to severely-emetogenic drugs the following guidelines in choosing the best antiemetic treatment can be given: 1. For the prevention of acute emesis induced by a high single dose of cisplatin (> or = 50 mg/m2) or by low doses (20 to 40 mg/m2) repeated for 4 to 5 days, the combination of ondansetron plus dexamethasone is the most efficacious and least toxic antiemetic therapy. 2. For the prevention of delayed emesis the combination of oral dexamethasone plus metoclopramide seems to offer the best protection, although over 40% of patients still experience delayed nausea and vomiting. 3. For the prevention of acute emesis induced by moderately emetogenic drugs, corticosteroids (dexamethasone or methylprednisolone) are efficacious and safe antiemetic agents. Although equally efficacious, the serotonin (5-HT)3 receptor antagonists, due to their higher acquisition costs, are indicated only in patients refractory to corticosteroids or in those who cannot use them. Unresolved problems in antiemetic research include: (i) identification of the best antiemetic treatment for those areas of cancer chemotherapy where adequate data are lacking, such as high dose regimens for bone marrow transplantation; (ii) optimisation of treatment for the most widely used chemotherapy regimens; and (iii) identification of the best rescue treatment for patients who fail to respond to antiemetic prophylaxis. Although many new 5-HT3 antagonists are currently being studied, the possible improvement in efficacy and tolerability brought about by these agents will probably only be marginal.
恶心和呕吐是癌症化疗最令人痛苦的不良反应。在过去十年中，化疗引起的呕吐的预防取得了相当大的进展。通过对接受中度至重度致吐药物治疗的患者所获结果进行分析，可给出以下选择最佳止吐治疗的指南：1. 为预防由高单次剂量顺铂（≥50mg/m²）或低剂量（20至40mg/m²）连续4至5天重复给药引起的急性呕吐，昂丹司琼加地塞米松联合用药是最有效且毒性最小的止吐疗法。2. 为预防延迟性呕吐，口服地塞米松加甲氧氯普胺联合用药似乎能提供最佳保护，尽管仍有超过40%的患者会经历延迟性恶心和呕吐。3. 为预防由中度致吐药物引起的急性呕吐，皮质类固醇（地塞米松或甲泼尼龙）是有效且安全的止吐剂。5-羟色胺（5-HT）3受体拮抗剂虽然同样有效，但因其获取成本较高，仅适用于对皮质类固醇难治或无法使用皮质类固醇的患者。止吐研究中尚未解决的问题包括：（i）对于癌症化疗中缺乏充分数据的领域，如骨髓移植的高剂量方案，确定最佳止吐治疗；（ii）优化最常用化疗方案的治疗；以及（iii）确定对抗吐预防无反应患者的最佳补救治疗。尽管目前正在研究许多新的5-HT3拮抗剂，但这些药物可能带来的疗效和耐受性的改善可能仅为边际性的。
