增加盐酸帕洛诺司琼给药次数预防顺铂化疗致吐的疗效分析

目的探讨增加盐酸帕洛诺司琼给药次数对预防含顺铂高度致吐性化疗所致恶心呕吐的有效性及安全性。方法回顾性分析如皋市人民医院2015年1月至2017年1月收治的接受含顺铂高度致吐性化疗100例恶性肿瘤患者临床资料,按盐酸帕洛诺司琼使用情况分为两组,研究组50例在化疗第1~3天治疗前30 min静脉推注盐酸帕洛诺司琼,对照组50例在化疗第1天和第3天治疗前30min静脉推注盐酸帕洛诺司琼,两组均观察1个化疗周期,统计研究组与对照组患者恶心、呕吐控制情况及给药安全性。结果研究组与对照组相比患者化疗急性期呕吐有效控制率差异无统计学意义(P0.05),延迟期呕吐、延迟期恶心及延迟期食欲减退的有效控制率两组差异均有统计学意义(均P0.05),其余不良反应两组差异无统计学意义(P0.05)。结论接受含顺铂高度致吐性方案多日化疗患者中提高盐酸帕洛诺司琼给药次数,具有增强预防恶心呕吐疗效,不良反应轻等优点。     

盐酸帕洛诺司琼注射液预防化疗引起恶心呕吐的临床疗效观察

  目的  观察盐酸帕洛诺司琼注射液预防化疗引起恶心呕吐的有效性和安全性。  方法  采用多中心、分层随机、双盲双模拟、自身交叉阳性对照临床试验设计,全部入组125例患者,分为A方案（61例）和B方案（64例）。A方案为每组患者随机采用在第1周期使用盐酸帕洛诺司琼注射液、第2周期使用盐酸格拉司琼注射液,B方案与之相反。试验组为A、B方案中所有使用试验药物的患者,对照组为A、B方案中所有使用对照药物的患者。行2个疗程化疗方案的试验组和对照组的急性和延迟性呕吐的完全控制率以及不良反应比较。  结果  中度致吐性化疗组中试验组的预防延迟性呕吐的完全控制率为76.92%（50/65）、对照组为55.38%（36/65）,两组差异具有统计学意义（P =0.011 0）。第1~5天中度致吐性化疗组中试验组的呕吐次数为（1.32±3.42）次、对照组为（1.94±3.03）次,两组之间比较差异具有统计学意义（P =0.009 6）。试验、对照组不良反应发生率均较低,程度也较轻。  结论  盐酸帕洛诺司琼预防中、高度致吐性化疗引起的急性及延迟性呕吐疗效确切,特别对预防中度致吐性化疗引起的延迟性呕吐,盐酸帕洛诺司琼优于盐酸格拉司琼,且盐酸帕洛诺司琼不良反应轻微,值得在临床上推广使用。      

盐酸帕洛诺司琼预防化疗所致恶心呕吐的疗效及安全性30例分析

[目的]观察盐酸帕洛诺司琼防治化疗所致恶心呕吐的疗效及安全性。[方法]60例非小细胞肺癌患者随机分为用盐酸帕洛诺司琼组和阿扎司琼组,每组30例。观察两组在控制急性呕吐(24h内)和延迟性呕吐(24～96h)的疗效差别及毒副反应情况。[结果]盐酸帕洛诺司琼和阿扎司琼防治急性呕吐的有效率(CR+PR)分别为93%和87%(P=0.667),防治延迟性呕吐的有效率分别为70%和30%(P=0.002)。两组分别有20%和23%的患者出现便秘、腹胀及头痛,两组间毒副反应比较无显著性差异(P>0.05)。[结论]盐酸帕洛诺司琼防治化疗所致的恶心呕吐疗效优于阿扎司琼,且安全性好,值得临床推广。     

帕洛诺司琼和恩丹西酮预防化疗诱发恶心呕吐的临床对比研究

目的:对比观察帕洛诺司琼和恩丹西酮预防化疗诱发恶心和呕吐的作用及其不良反应。方法:采用随机自身对照方法对36例接受中～高度致吐化疗药物的恶性肿瘤患者使用帕洛诺司琼进行止吐治疗,并与恩丹西酮作对照,于化疗第1个周期或第2个周期使用帕洛诺司琼止吐,同一患者于另1个周期使用恩丹西酮作自身对照。结果:帕洛诺司琼于急性呕吐期(化疗后24h内)止吐完全有效率为94.4%,恩丹西酮组为83.3%,帕洛诺司琼控制急性呕吐的疗效优于恩丹西酮,但两组比较差异无统计学意义,P>0.05。帕洛诺司琼于延迟呕吐期(化疗后d2～d5)止吐的有效率(完全有效率+部分有效率)均高于恩丹西酮,但两组差异均无统计学意义,P>0.05。帕洛诺司琼的不良反应主要为头痛和便秘,与恩丹西酮比较,两组主要不良反应发生率差异无统计学意义,P>0.05。结论:帕洛诺司琼能有效预防中、高度致吐化疗药物所致的恶心和呕吐反应,对于急性和延迟性呕吐反应相比恩丹西酮有较好疗效。     

帕洛诺司琼注射液预防化疗引起呕吐的疗效观察

目的 观察帕洛诺司琼注射液预防化疗引起呕吐的有效性和安全性.方法 采用多中心、分层随机、双盲双模拟、自身交叉对照临床试验设计,入组149例应用顺铂或蒽环类方案的恶性肿瘤患者.全部入组患者分为中致吐性化疗组,即顺铂≤50 mg/m2或多柔比星≥40 mg/m2(或吡柔比星≥40 mg/m2或表柔比星≥60 mg/m2),高致吐性化疗组,即顺铂≥60 mg/m2.患者连续化疗2个周期,化疗前分别应用帕洛诺司琼和格拉司琼,如第1周期应用试验药物(帕洛诺司琼),则第2周期应用对照药物(格拉司琼),反之则相反.对比患者应用试验药物的化疗周期(试验组)与应用对照药物的化疗周期(对照组)急性和延迟性呕吐的完全控制率以及不良反应.结果 预防急性呕吐的完全控制率:中致吐性试验组和对照组分别为50.72％、48.00％,高致吐性试验组和对照组分别为45.76％、52.24％,差异均无统计学意义(x2=0.153,P=0.695x2=0.924,P=0.337).预防延迟性呕吐的完全控制率:中致吐性试验组和对照组分别为59.42％ 、41.33％,差异有统计学意义(x2=4.673,P=0.031);而高致吐性试验组与对照组分别为37.29％、28.36％,差异无统计学意义(x2=0.956,P=0.328).第24小时至第5天呕吐次数的比较:中致吐性试验组中位数0.0次、对照组1.0次,差异有统计学意义(x2=7.765,P=0.005).试验、对照两组不良反应发生率均较低,程度也较轻.结论 帕洛诺司琼预防中、高致吐性化疗引起的急性及延迟性呕吐疗效确切,特别是在预防延迟性呕吐方面,帕洛诺司琼优于格拉司琼,且帕洛诺司琼不良反应轻微,值得在临床上推广使用.     

奥氮平预防中、高致吐化疗药物所致恶心、呕吐的临床观察

目的:观察奥氮平治疗中、高致吐性化疗药物所致恶心、呕吐的疗效和不良反应。方法:对80例应用中、高致吐性化疗药物的患者,随机分为干预组(IG)和对照组(CG),每组40例。对照组给予常规药物止吐,干预组在常规止吐药物的基础上加用奥氮平5mg,每晚口服。以上给药方案的时间与化疗时间一致。比较两组控制急性和延迟性恶心、呕吐的疗效差别及不良反应。结果:干预组和对照组急性恶心、呕吐的发生率分别为17.5%(7/40)和22.5%(9/40,P＞0.05）;迟发性恶心、呕吐的发生率分别为25.0%(10/40)和65%(26/40,P＜0.05）。治疗过程中的不良反应主要为嗜睡（32.5%和25.0%）、头晕（17.5%和16.7%）、水肿（12.5%和15.0%）、便秘（30.0%和35.0%）,两组不良反应发生率没有统计学差异。结论:奥氮平对延迟性恶心、呕吐的缓解率更优,且患者的不良反应可以耐受,具有临床推广价值。     

盐酸帕洛诺司琼预防化疗所致恶心呕吐的效果

目的观察酸帕洛诺司琼预防化疗所致恶心和呕吐的疗效和安全性。方法选取2012年1月至2013年12月间收治的100例恶性肿瘤患者,采用随机数字表法分成试验组和对照组,每组52例。试验组患者应用盐酸帕洛诺司琼,对照组患者应用盐酸托烷司琼。对化疗当日及化疗后1~7 d的恶心、呕吐程度、控制效果及不良反应进行评价。结果试验组和对照组患者用药后急性恶心控制率分别为78.0%和76.0%,急性呕吐控制率分别为80.0%和74.0%,差异无统计学意义(P>0.05)。试验组和对照组患者的延迟性呕吐控制率分别为70.0%和48.0%,差异有统计学意义(P<0.05)。结论盐酸帕洛诺司琼注射液对防治化疗引起的延迟性呕吐的疗效和安全性较好。     

阿瑞匹坦预防含顺铂化疗方案所致恶心和呕吐的临床观察

目的探讨阿瑞匹坦预防顺铂3天方案所致的恶心、呕吐的临床疗效及不良反应。方法选取在浙江省肿瘤医院2014年8月1日至2015年6月20日接受含顺铂(75 mg/m^2,分3天给药)两药联合化疗方案的肺癌初治患者108例,根据止吐药物使用情况分为阿瑞匹坦组(n=54)和对照组(n=54)。阿瑞匹坦组接受阿瑞匹坦(125 mg口服,d1;80 mg口服,d_2~d_3)、托烷司琼(5 mg静滴,d1~d6)和地塞米松(12 mg口服,d1;8 mg口服,d2~d4)治疗;对照组同期使用托烷司琼(5 mg静滴,d_1~d_6)和地塞米松(12 mg口服,d1;8 mg口服,d_2~d_4)。观察两组化疗后急性期(0~24 h)、延迟期(24~120 h)呕吐的完全缓解率、化疗期间(0~120 h)3~4级恶心、呕吐的发生率。参照CTCAE 4.0对不良反应分级,采用呕吐生活功能指数(FLIE)评估两组生活质量。结果阿瑞匹坦组与对照组治疗急性呕吐的完全缓解率分别为90.7%和75.9%(P=0.039);两组治疗迟发性呕吐的完全缓解率分别为81.5%和61.1%(P=0.019)。化疗期间阿瑞匹坦组与对照组3~4级恶心和呕吐发生率分别为18.5%和37.0%(P=0.032)。阿瑞匹坦组与对照组患者生活质量评分分别为111.67±17.02和104.89±17.32(P=0.047)。阿瑞匹坦组患者便秘、呃逆症状的发生率明显高于对照组(P<0.05)。结论阿瑞匹坦预防顺铂3天方案的化疗方案所致恶心呕吐的疗效良好,能提高接受高致吐化疗方案肺癌患者的生存质量,不良反应有待进一步观察。     

盐酸帕洛诺司琼预防含顺铂方案化疗所致胃肠道反应的疗效观察

顺铂为高致吐性化疗药物,引起的胃肠道反应较为严重。高选择性的5-HT3受体拮抗剂如昂丹司琼、格拉司琼及托烷司琼的临床使用,使化疗所致的恶心、呕吐明显减少,但这些药物对延迟性呕吐疗效较差。盐酸帕洛诺司琼是由瑞士Helsinn公司研发的第二代5-HT3受体拮抗剂类止吐药。我科2011年11月～2012年3月对48例帕洛诺司琼预防顺铂所致呕吐反     

福沙匹坦三联用药预防高致吐化疗方案所致恶心呕吐疗效的临床观察

目的:评估福沙匹坦、盐酸托烷司琼、地塞米松三联方案预防高致吐化疗方案致恶心呕吐的效果及安全性。方法:采取回顾性分析的方法,选择2013年1月至2018年4月空军军医大学唐都医院肿瘤科收治的乳腺癌接受高致吐性化疗方案初次化疗的患者81例,根据预防化疗相关性恶心呕吐(chemotherapy-induced nausea and vomiting,CINV)方案的不同设置为观察组和对照组。对照组42例给予盐酸托烷司琼、地塞米松二联方案预防CINV。观察组39例,在对照组治疗基础上加用福沙匹坦。对比两组化疗后急性期(0～24 h)及延迟期(24～120 h)预防恶心呕吐的效果及不良反应的发生情况。结果:观察组患者化疗后恶心控制率显著高于对照组（87.2% vs 69.0%,P＜0.05);急性期观察组呕吐有效控制率为87.2%,显著高于对照组的66.7%(P＜0.05);呕吐延迟期内观察组和对照组的有效控制率分别为74.4%和57.1%,差异有统计学意义(P<0.05) 。两组不良反应发生率比较差异无统计学意义(P＞0.05),且不良反应均较轻微,患者可耐受。结论:福沙匹坦三联方案对高致吐化疗方案蒽环类药物联合环磷酰胺化疗致乳腺癌患者的恶心呕吐疗效显著,且不良反应轻微,患者可耐受。     

重复使用5-HT3受体拮抗剂预防多日化疗相关性恶心呕吐的疗效和安全性分析

  目的  探讨重复使用第一代5-HT3受体拮抗剂（5-HT3RA）托烷司琼与第二代5-HT3RA帕洛诺司琼预防多日高度催吐风险化疗所致恶心和呕吐（chemotherapy-induced nausea and vomiting,CINV）的疗效和安全性。  方法  在接受含有高度催吐风险药物连续多日化疗的患者中,采用随机、交叉自身对照的方法分组,A方案组为:在第1周期化疗中,帕洛诺司琼0.25 mg,静脉滴注,d1、d3（必要时d5）。地塞米松（DXM）10 mg,静脉滴注,d1;5 mg,静脉滴注,d2~d5。第2周期为托烷司琼5 mg,静脉滴注,d1~d3（必要时d4、d5）;DXM用法同前。B方案组的止吐方案为第1周期使用托烷司琼,第2周期使用帕洛诺司琼（剂量、用法均同A方案组）。将A方案组第1个周期和B方案组第2个周期的患者归为帕洛诺司琼组,A方案第2个周期和B方案组第1个周期的患者归为托烷司琼组,比较帕洛诺司琼与托烷司琼预防CINV的疗效和不良反应。  结果  共计入组91例患者。在d3至d5,帕洛诺司琼组每天恶心发生率分别为28.6%、30.8%和24.2%,托烷司琼组分别为42.8%、47.3%和39.6%,差异均有统计学意义（均P < 0.05）;在d4至d6,帕洛诺司琼组每天呕吐发生率分别为28.6%、18.7%和5.5%,托烷司琼组则为42.9%、34.1%和14.3%,差异均有统计学意义（均P < 0.05）;按时间段分析,帕洛诺司琼组在d4~5、d6~7和全程（d1~7）恶心和呕吐发生率均显著低于托烷司琼组（均P < 0.05）。帕洛诺司琼组全程（d1~7）解救药使用率为13.2%,低于托烷司琼组的24.2%,但差异无统计学意义（P=0.057）。帕洛诺司琼组与托烷司琼组的止吐药物相关性不良反应发生率的差异均无统计学意义（均P > 0.05）。  结论  重复使用帕洛诺司琼预防持续多日高度催吐风险化疗相关的延迟性恶心呕吐的疗效优于托烷司琼,两者的安全性良好。      

Phase II Study on EANI Combined with Hydrochloride Palonosetron for Prevention of Chemotherapy-induced Nausea and Vomiting Following Highly Emetogenic Chemotherapy

Objective: To investigate the electronic anti-nausea instrument (EANI) combined with hydrochloridepalonosetron for prevention of chemotherapy-induced nausea and vomiting following highly emetogenicchemotherapy. Methods: Patients who received highly emetogenic chemotherapy were randomly assigned toa treatment group (60 patients) treated with EANI combined with hydrochloride palonosetron, and controlgroup (also 60 patients) given only hydrochloride palonosetron. Chemotherapy related nausea and vomitingwere observed and recorded in both groups of patients from the start till the end of chemotherapy. Results:Complete control rates of vomiting in treatment and control group were 40%, and 35%, respectively, withoutany statistical ly significant difference (p> 0.05); however the response rates are 95.0%, 78.3%, respectively, withstatistical difference (p< 0.05). Complete control rates of nausea in treatment and control group were 36.7%,30%, respectively, without statistical difference (p> 0.05); but the response rates are 90.0%, 76.7%, respectively,with statistical difference (p<0.05). Conclusion: EANI combined with hydrochloride palonosetron for preventionof nausea and vomiting induced by chemotherapy could be more effective than hydrochloride palonosetron alone,and can be recommended for use in prevention and treatment of chemotherapy-induced nausea and vomitingfollowing highly emetogenic chemotherapy.     

Clinical research of Olanzapine for prevention of chemotherapy-induced nausea and vomiting

Background

This study was designed to mainly evaluate the activity and safety of olanzapine compared with 5-hydroxytryptamine3(5-HT₃) receptor antagonists for prevention of chemotherapy-induced nausea and vomiting(CINV) in patients receiving highly or moderately emetogenic chemotherapy (HEC or MEC). The second goal was to evaluate the impact of olanzapine on quality of life (QoL) of cancer patients during the period of chemotherapy.

Methods

229 patients receiving highly or moderately emetogenic chemotherapy were randomly assigned to the test group [olanzapine(O) 10 mg p.o. plus azasetron (A) 10 mg i.v. and dexamethasone (D) 10 mg i.v. on day 1; O 10 mg once a day on days 2-5] or the control group (A 10 mg i.v. and D 10 mg i.v. on day 1; D 10 mg i.v. once a day on days 2-5). All the patients filled the observation table of CINV once a day on days 1-5, patients were instructed to fill the EORTC QLQ-C30 QoL observation table on day 0 and day 6. The primary endpoint was the complete response (CR) (without nausea and vomiting, no rescue therapy) for the acute period (24 h postchemotherapy), delayed period (days 2-5 poschemotherapy), the whole period (days 1-5 postchemotherapy). The second endpoint was QoL during chemotherapy administration, drug safety and toxicity.

Results

229 patients were evaluable for efficacy. Compared with control group, complete response for acute nausea and vomiting in test group had no difference (p > 0.05), complete response for delayed nausea and vomiting in patients with highly emetogenic chemotherapy respectively improved 39.21% (69.64% versus 30.43%, p < 0.05), 22.05% (78.57% versus 56.52%, p < 0.05), complete response for delayed nausea and vomiting in patients with moderately emetogenic chemotherapy respectively improved 25.01% (83.07% versus 58.06%, p < 0.05), 13.43% (89.23% versus 75.80%, p < 0.05), complete response for the whole period of nausea and vomiting in patients with highly emetogenic chemotherapy respectively improved 41.38% (69.64% versus 28.26%, p < 0.05), 22.05% (78.57% versus 56.52%, p < 0.05), complete response for the whole period of nausea and vomiting in patients with moderately emetogenic chemotherapy respectively improved 26.62% (83.07% versus 56.45%, p < 0.05), 13.43% (89.23% versus 75.80%, p < 0.05). 214 of 299 patients were evaluable for QoL. Comparing test group with control group in QoL evolution, significant differences were seen in global health status, emotional functioning, social functioning, fatigue, nausea and vomiting, insomnia and appetite loss evolution in favour of the test group (p < 0.01). Both treatments were well tolerated.

Conclusion

Olanzapine can improve the complete response of delayed nausea and vomiting in patients receiving the highly or moderately emetogenic chemotherapy comparing with the standard therapy of antiemesis, as well as improve the QoL of the cancer patients during chemotherapy administration. Olanzapine is a safe and efficient drug for prevention of CINV.     

Pathogenesis-based treatment of chemotherapy-induced nausea and vomiting--two new agents

Chemotherapy-induced nausea and vomiting (CINV) is associated with a significant deterioration in quality of life. The emetogenicity of the chemotherapeutic agents, repeated chemotherapy cycles, and patient risk factors (female gender, younger age, alcohol consumption, history of motion sickness) are the major risk factors for CINV. The use of 5-hydroxytryptamine3 (5-HT3) receptor antagonists plus dexamethasone has significantly improved the control of acute CINV, but delayed nausea and vomiting remains a significant clinical problem. Although the 5-HT3 receptor antagonists, dexamethasone, and metoclopramide have been used to prevent delayed CINV, only dexamethasone appears to have much efficacy with acceptable toxicity. Recent studies have introduced two new agents, palonosetron and aprepitant, for the prevention of both acute and delayed CINV. Palonosetron is a new 5-HT3 receptor antagonist with a longer half life and a higher binding affinity than older 5-HT3 receptor antagonists. It improves the complete response rate (no emesis, no need for rescue) of acute and delayed CINV in patients receiving moderately emetogenic chemotherapy compared to the older 5-HT3 receptor antagonists.The other agent, aprepitant, is the first agent available in the new drug class of neurokinin-1 receptor antagonists. When added to a standard regimen of a 5-HT3 receptor antagonist and dexamethasone in patients receiving highly emetogenic chemotherapy, it improves the complete response rate of acute CINV. Aprepitant also improves the complete response of delayed CINV when compared to placebo and when used in combination with dexamethasone compared to dexamethasone alone. Acute and delayed nausea may also be improved by aprepitant when used in combination with a 5-HT3 and dexamethasone prechemotherapy or with daily dosing for 3-5 days following chemotherapy. Based on these studies, new guidelines for the prevention of CINV are proposed. Future studies may consider the use of palonosetron and aprepitant with current and other new agents (olanzapine, gabapentin) in moderately and highly emetogenic chemotherapy, as well in the clinical settings of multiple-day chemotherapy and bone marrow transplantation.     

Palonosetron: a second-generation 5-hydroxytryptamine receptor antagonist

Chemotherapy-induced nausea and vomiting (CINV) is associated with a significant deterioration in quality of life. The emetogenicity of the chemotherapeutic agents, repeated chemotherapy cycles and patient risk factors (female gender, younger age, alcohol consumption, history of motion sickness) are the major risk factors for CINV. The use of 5-hydroxytryptamine (5-HT)3 receptor antagonists plus dexamethasone has significantly improved the control of acute CINV, but delayed nausea and vomiting remains a clinical problem. A new agent, palonosetron, has recently been approved for the prevention of acute CINV in patients receiving either moderately or highly emetogenic chemotherapy and for the prevention of delayed CINV in patients receiving moderately emetogenic chemotherapy. Palonosetron is a 5-HT3 receptor antagonist with a longer half-life and a higher binding affinity than first-generation 5-HT3 receptor antagonists. In a single dosing study, palonosetron was highly effective in controlling CINV compared with a single dose of dolasetron or ondansetron in patients receiving moderately emetogenic chemotherapy. Palonosetron in combination with dexamethasone demonstrated control of CINV in patients receiving highly emetogenic chemotherapy. Palonosetron appeared to be as effective in subsequent courses of chemotherapy compared with the initial course of chemotherapy. There were no clinically relevant differences seen among palonosetron, ondansetron or dolasetron in laboratory, electrocardiographic or vital-sign changes, and adverse reactions reported in the clinical trials were the most common reactions reported for the 5-HT3 receptor antagonist class. Recent studies using palonosetron-based anti-emetic combinations in moderately and highly emetogenic chemotherapy, as well as in the clinical setting of multiple-day chemotherapy, have been reported. Future studies may consider the use of palonosetron with current and other new agents and in other clinical settings, such as bone marrow transplantation and radiation therapy.     

Recent developments in the prevention of chemotherapy-induced nausea and vomiting (CINV): a comprehensive review

The prevention of chemotherapy-induced nausea and vomiting (CINV) has been revolutionized over the past 25 years. Guideline-based treatment means that vomiting can be prevented in the majority, but not in all patients. Therefore, antiemetic research continues with the goal of optimizing CINV control for all patients. This comprehensive review summarizes the research efforts in this field over the past few years. Emerging from this research are two new antiemetic agents, netupitant/palonosetron, the first antiemetic combination agent and rolapitant, a new NK₁RA. In addition, studies have evaluated the benefits of olanzapine and ginger, explored optimal combinations of agents for delayed CINV prevention, confirmed that dexamethasone-sparing regimens are effective, and demonstrated the value of NK₁RAs in high-dose chemotherapy settings as well as with certain moderately emetogenic chemotherapies such as carboplatin. Research has also validated the correlation between antiemetic guideline adherence and improved CINV control. Finally, regulatory authorities have utilized extreme caution in retiring some 5-HT₃RAs or decreasing their maximum dose.     

帕洛诺司琼在鼻咽癌同步放化疗中防治恶心呕吐的疗效观察

目的：对接受同步放化疗的鼻咽癌患者采用帕洛诺司琼预防恶心呕吐,观察其治疗效果。方法将行同步放化疗的鼻咽癌患者80例随机分为2组,分别采用帕洛诺司琼和昂丹司琼止吐治疗,观察并比较2组患者发生急性、延迟性恶心呕吐及其他不良反应的情况。结果帕洛诺司琼组急性恶心发生率为57．5％、急性呕吐32．5％,昂丹司琼组急性恶心、呕吐的发生率为62．5％、35．0％,2组比较差异无统计学意义（P＞0．05）;帕洛诺司琼组延迟性恶心、延迟性呕吐发生率分别为80．0％、62．5％,昂丹司琼组延迟性恶心、呕吐的发生率为87．5％、80．0％,帕洛诺司琼组明显降低,差异有统计学意义（P＜0．05）。除恶心、呕吐的消化道反应外,2组患者均出现头晕、口干、头痛、乏力、低热、便秘、焦虑、腹泻等放化疗相关不良反应,2组的不良反应发生率无明显差异（P＞0．05）。结论对接受同步放化疗的鼻咽癌患者采用帕洛诺司琼,能够预防放化疗引起的急性及延迟性恶心呕吐,尤其是能够有效控制延迟性恶心呕吐的发生,且不良反应轻微,值得在临床上推广使用。     

Palonosetron improves prevention of chemotherapy-induced nausea and vomiting in elderly patients

Although elderly patients have been reported to be less prone to chemotherapy-induced nausea and vomiting (CINV), its management is complicated by a high frequency of comorbidities and polypharmacy and an increased risk of dehydration and impaired cognition.The comparative efficacy and tolerability of palonosetron and ondansetron/dolasetron were assessed in a retrospective post hoc analysis using pooled data from 171 elderly patients (age > or = 65 years) with cancer enrolled in two randomized, double-blind, phase III clinical studies comparing single IV doses of these antiemetic agents given prior to receipt of moderately emetogenic chemotherapy.The complete response rate during the postchemotherapy period was significantly higher in the palonosetron group than in the ondansetron/dolasetron group in the 5 days following chemotherapy.The proportion of patients who were nausea-free on the problematic days 2 and 3 post chemotherapy and the time to treatment failure also significantly favored palonosetron. In this population that included patients with pre-existing comorbidities, palonosetron was well tolerated, with similar or fewer adverse events than the comparators. Comparisons in electrocardiogram parameters revealed that the mean postdose change from baseline in QTc interval was 3 ms for palonosetron 0.25 mg and 5 ms for ondansetron/dolasetron. In this retrospective analysis, palonosetron provided superior efficacy to ondansetron/dolasetron for the treatment of CINV in elderly patients receiving moderately emetogenic chemotherapy. Based on its safety profile, antiemetic control, and convenient dosing, palonosetron can be recommended for use in elderly patients with cancer receiving emetogenic chemotherapy.     

阿瑞匹坦对妇科恶性肿瘤化疗相关不良反应的影响

目的 观察阿瑞匹坦治疗妇科恶性肿瘤患者化疗后恶心呕吐的疗效及对血红蛋白水平的影响。方法 收治我院85例妇科恶性肿瘤患者,根据患者止吐药物使用情况分为阿瑞匹坦组和对照组,对照组予以化疗及常规对症处理,阿瑞匹坦组在对照组的基础上加用阿瑞匹坦,观察两组恶心呕吐、血红蛋白水平以及外周血象等变化。结果 阿瑞匹坦组患者化疗后恶心、呕吐发生率低（P<0.05）,但两组头晕、头痛等其他不良反应发生率差异均无明显统计学意义（P>0.05）。化疗后红细胞数下降的程度稍轻于对照组（P>0.05）。结论 阿瑞匹坦不仅可以有效预防化疗所致恶心、呕吐的发生,提高患者生活质量和治疗依从性,还可使患者尽早进食,有利于血红蛋白的生成,减弱肿瘤负荷和化疗所致贫血程度。