Roila F, Tonato M, Del Favero A
Medical Oncology Division, Policlinico Hospital, Perugia, Italy.
Dig Dis. 1993 Nov-Dec;11(6):343-53. doi: 10.1159/000171426.
In the last decade research on antiemetic therapy has determined relevant advances in the prevention of chemotherapy-induced emesis. In fact, 70-80% of patients submitted to highly or moderately emetogenic drugs achieve complete protection against vomiting during the first cycle of chemotherapy. In the prevention of acute emesis induced by a high single dose (> or 50 mg/m2) or a low dose (20-40 mg/m2) of cisplatin repeated for 4-5 days, a combination of ondansetron plus dexamethasone was shown to be more efficacious and less toxic than the combination of high dose metoclopramide plus dexamethasone plus diphenhydramine. Few studies have been performed for the prevention of delayed emesis induced by cisplatin. At present, the combination of oral dexamethasone plus metoclopramide seems to offer the best protection and should be considered the treatment of choice. For the prevention of acute emesis induced by moderately emetogenic drugs, corticosteroids (dexamethasone and methylprednisolone) and the new 5-HT3 receptor antagonists have a similar efficacy and a low toxicity. On a cost basis, corticosteroids must be considered the drug of choice while 5-HT3 receptor antagonists should be used only in patients refractory to corticosteroids or in those who cannot tolerate them.
在过去十年中，关于止吐疗法的研究在预防化疗引起的呕吐方面取得了显著进展。事实上，接受高致吐性或中度致吐性药物治疗的患者中，70%-80%在化疗的第一个周期中能够完全预防呕吐。在预防由高单次剂量（>或50mg/m²）或低剂量（20-40mg/m²）顺铂重复给药4-5天引起的急性呕吐时，与高剂量甲氧氯普胺加地塞米松加苯海拉明联合使用相比，昂丹司琼加地塞米松联合使用显示出更有效且毒性更低。关于预防顺铂引起的迟发性呕吐的研究较少。目前，口服地塞米松加甲氧氯普胺联合使用似乎能提供最佳保护，应被视为首选治疗方法。对于预防中度致吐性药物引起的急性呕吐，皮质类固醇（地塞米松和甲泼尼龙）和新型5-HT3受体拮抗剂具有相似的疗效且毒性较低。从成本角度考虑，皮质类固醇应被视为首选药物，而5-HT3受体拮抗剂仅应用于对皮质类固醇难治或无法耐受的患者。
