Morrow G R, Hickok J T, Rosenthal S N
University of Rochester, Cancer Center, New York 14642, USA.
Cancer. 1995 Aug 1;76(3):343-57. doi: 10.1002/1097-0142(19950801)76:3<343::aid-cncr2820760302>3.0.co;2-v.
Nausea and vomiting are the most distressing side effects associated with the administration of chemotherapy for neoplastic diseases. Nausea, in particular, often had been ignored in studies of chemotherapy side effects. Recently, progress has been made in the control of chemotherapy-induced nausea and vomiting, due, in part, to a better understanding of the physiologic mechanisms involved.
This paper reviews recent advances in the control of emesis, focusing on pharmacologic treatments.
The efficacy and safety of the serotonin (5-HT3) receptor antagonists granisetron, ondansetron, and tropisetron in the control of acute and delayed emesis and emesis induced by repeat-cycle chemotherapy are summarized. Although differences in study design and definitions of response criteria have made it difficult to compare the studies that have evaluated these three agents, the overall body of literature supports several clinical findings.
(1) The 5HT3 antiemetic agents have been shown to be clinically more effective in the control of nausea and emesis than previously used agents. (2) No one of the three has demonstrated consistently greater efficacy. (3) Efficacy appears to be more pronounced for cisplatin-containing regimens than for moderate or less emetogenic chemotherapy regimens. (4) Effectiveness of the 5HT3 agents appears to be less for delayed nausea and emesis than for acute symptoms. Potential control of anticipatory nausea and emesis has not been investigated. (5) Control over nausea appears to be significantly less than control over emesis. In the studies in which it has been measured, nausea control remains incomplete for approximately half the patients given 5HT3 agents. (6) The efficacy of the agents appears to diminish across repeated days and, perhaps, across repeated chemotherapy cycles. (7) The addition of a steroid such as dexamethasone increases the efficacy of both 5HT3 and other antiemetic agents. This effect also seems to apply to delayed nausea and emesis.
恶心和呕吐是肿瘤疾病化疗过程中最令人痛苦的副作用。尤其是恶心，在化疗副作用研究中常常被忽视。近来，在控制化疗引起的恶心和呕吐方面取得了进展，部分原因是对其中涉及的生理机制有了更好的理解。
本文综述了呕吐控制方面的最新进展，重点是药物治疗。
总结了5-羟色胺（5-HT3）受体拮抗剂格拉司琼、昂丹司琼和托烷司琼在控制急性和迟发性呕吐以及重复周期化疗引起的呕吐方面的疗效和安全性。尽管研究设计和反应标准定义的差异使得难以比较评估这三种药物的研究，但总体文献支持了一些临床发现。
（1）已证明5-HT3止吐药在控制恶心和呕吐方面比以前使用的药物在临床上更有效。（2）这三种药物中没有一种一直显示出更高的疗效。（3）含顺铂方案的疗效似乎比中度或低度致吐性化疗方案更显著。（4）5-HT3药物对迟发性恶心和呕吐的疗效似乎比对急性症状的疗效要低。预期性恶心和呕吐的潜在控制尚未研究。（5）对恶心的控制似乎明显低于对呕吐的控制。在已进行测量的研究中，接受5-HT3药物治疗的患者中约有一半的恶心控制仍不完全。（6）这些药物的疗效似乎在连续几天以及可能在重复化疗周期中逐渐降低。（7）添加地塞米松等类固醇可提高5-HT3和其他止吐药的疗效。这种作用似乎也适用于迟发性恶心和呕吐。
