阿瑞匹坦预防顺铂化疗所致恶心和呕吐的疗效分析

目的:为明确阿瑞匹坦在预防含顺铂的化疗方案所致的化疗相关性恶心呕吐的临床疗效。方法:选取我院2014年1月1日–2014年10月1日接受含顺铂(75 mg·m-2)化疗方案的患者100例,接受阿瑞匹坦、5-HT3受体拮抗剂和地塞米松的患者为阿瑞匹坦组,同期使用5-HT3受体拮抗剂和地塞米松的患者为对照组,观察两组患者急性期(第1天)、延迟期(第2~5天)完全有效率(CR)及化疗期间(5 d)无严重恶心呕吐的发生率。结果:阿瑞匹坦组与对照组治疗急性呕吐的CR分别为70%和54%(P=0.149);而治疗迟发性呕吐两组有效率分别为78%和46%(P=0.002),阿瑞匹坦组显著优于对照组。化疗期间阿瑞匹坦组与对照组患者无严重恶心呕吐的发生率分别为86%、62%(P=0.012),阿瑞匹坦组优于对照组。两组止吐药物相关不良反应无明显差异。结论:阿瑞匹坦三联方案在预防顺铂诱发恶心和呕吐的疗效及耐受性方面表现良好,为提高患者生活质量提供了较好的选择方式。     

昂丹司琼联合阿瑞匹坦胶囊及地塞米松治疗化疗致呕吐的效果分析

目的 探讨昂丹司琼联合阿瑞匹坦胶囊及地塞米松治疗化疗致呕吐的效果。方法 选择医院2020年3月～2021年3月诊治的乳腺癌化疗呕吐患者100例,采用简单随机化法将所有患者分成对照组(n=50)和联合组(n=50)。对照组患者使用昂丹司琼治疗,联合组患者使用昂丹司琼联合阿瑞匹坦胶囊及地塞米松治疗。比较两组患者止吐疗效、恶心呕吐分级及不良反应。结果 联合组患者止吐总有效率76%高于对照组48%(χ²=9.556,P <0.05)。两组患者经秩和检验发现,差异有统计学意义(Z=3.619,P <0.05)。两组患者不良反应发生率差异无统计学意义(χ²=0.391,P> 0.05)。结论 昂丹司琼联合阿瑞匹坦胶囊及地塞米松治疗化疗致呕吐患者可在不增加治疗不良反应基础上改善恶心呕吐程度,提升临床疗效。     

阿瑞匹坦在预防肺癌含铂化疗方案所致化疗相关性恶心呕吐的疗效研究

目的分析研讨阿瑞匹坦在预防肺癌含铂化疗方案所致化疗相关性恶心呕吐的疗效。方法随机抽取我院2015年9月~2017年10月期间收治的肺癌含铂化疗方案治疗而引发恶心呕吐患者80例,根据其所使用止吐药物进行分组,对照组40例接受地塞米松+托烷司琼治疗,研究组40例接受阿瑞匹坦+地塞米松+托烷司琼治疗,观察比较两组患者治疗疗效、不良反应,以及患者生活质量等。结果研究组治疗总有效率为90%高于对照组的72.50%,P0.05。研究组不良反应总发生率15%虽略低于对照组12.50%,P0.05。对比两组患者FLIE评分,治疗前P0.05,治疗后,研究组评分均高于对照组,P0.05。研究组首次呕吐时间晚于对照组,P0.05,表明阿瑞匹坦药物在预防化疗相关性恶心呕吐方面有应用价值。结论临床治疗肺癌含铂化疗而造成的恶心呕吐症状可在地塞米松联合托烷司琼治疗基础上,给予阿瑞匹坦药物,止吐效果更好,且可确保给药安全性,进而提升患者生活质量。     

阿瑞匹坦用于肺腺癌紫杉醇联合顺铂化疗引起恶心呕吐的临床研究

目的观察阿瑞匹坦在肺腺癌紫杉醇联合顺铂方案化疗中的急性期及延迟期止吐疗效和安全性。方法 50例肺腺癌患者,均接受紫杉醇联合顺铂的TP方案化疗,随机分为实验组及对照组,每组25例。对照组患者接受5-HT3受体拮抗剂托烷司琼、地塞米松预防止吐,实验组在对照组基础上联合应用阿瑞匹坦预防止吐。完成1个周期化疗后,评估两组患者在化疗后急性期及延迟期恶心呕吐情况及不良反应。结果 50例患者均按期完成1个周期的TP方案化疗,实验组和对照组急性恶心、呕吐完全缓解率(CR)分别为44%和32%(χ~2=0.764,P>0.05),有效率(RR)分别为80%和72%(χ~2=0.439,P>0.05),差异无统计学意义。实验组和对照组延迟性恶心呕吐CR分别为52%和24%(χ~2=4.160,P<0.05),RR分别为76%和44%(χ~2=5.333,P<0.05),差异有统计学意义。两组患者不良反应主要包括头晕、乏力、呃逆、腹胀、便秘,均为轻度,差异无统计学意义。结论阿瑞匹坦联合托烷司琼、地塞米松方案预防肺腺癌紫杉醇联合顺铂化疗引起的急性期及延迟期恶心呕吐疗效确切,安全性高,值得临床进一步应用推广。     

阿瑞匹坦在含顺铂方案化疗中的止吐疗效观察

目的:比较含顺铂化疗方案中常规止吐方案加用阿瑞匹坦与单用常规止吐方案的疗效差异。方法:106例肺癌患者均采用含顺铂的双药方案联合化疗,其中53例(对照组)予常规止吐治疗,另外53例(观察组)在常规止吐治疗的基础上加服NK-1受体拮抗剂阿瑞匹坦,观察两组的止吐效果。结果:对照组止吐有效率为77.36%,观察组止吐有效率为96.23%,两组比较差异有统计学意义(χ2=8.23,P<0.05)。结论:NK-1受体拮抗剂阿瑞匹坦联合5-HT3受体拮抗剂如托烷司琼及皮质类固醇类药物地塞米松可显著改善顺铂化疗所致的恶心、呕吐症状,明显改善化疗患者的生活质量,提高患者的依从性,从而保证化疗的顺利进行。     

阿瑞匹坦联合托烷司琼预防顺铂化疗引起呕吐的临床观察

目的:观察阿瑞匹坦联合托烷司琼方案预防顺铂化疗引起呕吐的疗效及不良反应。方法:采用随机、自身交叉对照的方法,将60例接受两周期含顺铂联合化疗的患者,随机分为AB、BA组。AB组第1周期应用阿瑞匹坦联合托烷司琼,第2周期应用托烷司琼;BA组第1周期应用托烷司琼,第2周期应用阿瑞匹坦联合托烷司琼。结果:可评价疗效的59例患者中,阿瑞匹坦联合托烷司琼方案和托烷司琼方案对急性呕吐的完全缓解率分别为74.6%和57.6%,有效控制率分别为91.5%和81.4%(Z=-2.017,P=0.044);对延迟性呕吐的完全缓解率分别为69.5%和42.4%,有效控制率分别为86.4%和71.2%(Z=-3.112,P=0.002)。两种方案的主要不良反应为呃逆、便秘、头痛、头晕、口干等,不良反应发生率比较差异无统计学意义(P>0.05)。结论:阿瑞匹坦联合托烷司琼方案对顺铂化疗引起急性呕吐与延迟性呕吐均有很好的疗效,不良反应可以耐受。     

阿瑞匹坦对乳腺癌AC方案化疗后中重度呕吐患者的二级预防

目的 观察分析联合应用阿瑞匹坦、盐酸托烷司琼、地塞米松二级预防乳腺癌术后蒽环类药物联合环磷酰胺（AC方案）化疗所致恶心呕吐的疗效及不良反应。方法 选取2015年1月至2016年5月在山东省德州市市立医院肿瘤科住院治疗的乳腺癌术后AC方案首次化疗相关性恶心呕吐（chemotherapy-induced nausea and vomiting,CINV）为中重度的患者72例,随机分为观察组35例,对照组37例。继续化疗过程中,观察组使用阿瑞匹坦+盐酸托烷司琼+地塞米松三联止吐药物预防CINV,对照组使用盐酸托烷司琼+地塞米松预防CINV。观察两组患者化疗后急性期（0~24 h）及延迟期（24~120 h）预防恶心呕吐的效果及不良反应发生情况。结果 两组患者急性期呕吐的完全控制率比较,差异无统计学意义（P>0.05）,观察组急性期呕吐的有效控制率较对照组明显升高,差异有统计学意义（P<0.05）;观察组延迟期呕吐的完全控制率及有效控制率均高于对照组,差异均有统计学意义（P<0.05）。两组患者不良反应主要为便秘、疲乏、面色潮红、焦虑及头晕等,均症状轻微。结论 对乳腺癌AC方案化疗后中重度呕吐患者,化疗过程中给予阿瑞匹坦三联止吐治疗效果好,经济效益较高,且不良反应轻微,患者可耐受。     

阿瑞吡坦联合昂丹司琼及地塞米松防治直肠癌患者术后化疗相关性恶心呕吐临床观察

摘 要 目的：探讨阿瑞吡坦联合昂丹司琼及地塞米松防治直肠癌患者术后mFOLFOX6方案化疗相关性恶心呕吐的临床疗效。方法：122例接受术后mFOLFOX6方案化疗的直肠癌患者随机分入观察组（阿瑞吡坦+昂丹司琼+地塞米松）和对照组（昂丹司琼+地塞米松）进行预防性止吐。记录患者恶心、呕吐及其他不良反应,并评估化疗相关性恶心呕吐对患者生活质量的影响。结果：观察组急性呕吐和延迟性呕吐控制有效率分别为80.0%和83.3%,均显著优于对照组（P<0.05）。两组恶心控制有效率差异无统计学意义（P >0.05）。观察组患者生活质量评分显著高于对照组（P＜0.01）,且观察组对生活质量产生负面影响的人数明显少于对照组（P＜0.01）。结论：阿瑞吡坦联合昂丹司琼及地塞米松对术后mFOLFOX6方案化疗的直肠癌患者发生呕吐的控制作用显著,同时能改善患者的生活质量,且未造成更多不良反应。     

止吐新药阿匹坦介绍

目的:介绍止吐新药阿匹坦的药动学、药效学、临床应用进展及不良反应等.方法:评述国内外近期相关文献.结果:阿匹坦特异性拮抗在化疗呕吐中起重要作用的速激肽--P物质,可与5-羟色胺3(5-HT3)受体拮抗剂联合用药,临床总有效率达63%～73%.结论:阿匹坦是第一个神经激肽(NK1)受体拮抗剂,可阻止化疗患者的呕吐特别是迟发性呕吐;阿匹坦、昂丹司琼和地塞米松联合应用可积极预防急性和迟发性呕吐,有效率高于单独使用昂丹司琼和地塞米松;该药不良反应轻微;但与CYP3A4和CYP2C9有关的药物合用需持谨慎态度.     

不同疗程地塞米松联合阿瑞匹坦、托烷司琼预防蒽环类药物引起乳腺癌患者恶心及呕吐的临床研究

目的:探讨不同疗程的地塞米松联合5-HT3受体拮抗剂和NK-1受体拮抗剂对预防乳腺癌患者接受蒽环类药物和环磷酰胺化疗方案(AC或EC)引起高度恶心呕吐(CINV)的疗效。方法:采用前瞻性研究方法选择2018年1月1日-2018年6月30日接收AC或EC的乳腺癌患者84例,随机分为对照组48例(第1~3天受地塞米松10 mg),观察组36例(第1天接受地塞米松10 mg)。在整个研究期间通过患者研究日志记录其对治疗的反应。主要研究终点为完全缓解率(CR),次要研究终点包括急性期CR、延迟期CR;完全控制率(CC)、急性期CC、延迟期CC,以及这种止吐治疗的安全性。结果:2组患者均接受6个化疗周期,且其一般临床资料均无显著性学差异。观察组与对照组急性期及延迟期CINV的CR分别是(94.4%vs 87.5%,P>0.05),(88.9%vs 91.7%,P>0.05);CINV的总CR为(80.6%vs 81.3%,P>0.05);观察组与对照组急性期及延迟期CINV的CC分别是(55.6%vs 60.4%,P>0.05),(63.9%vs 68.8%,P>0.05);CINV的总CR为(47.2%vs 54.2%,P>0.05);且各组间无显著性差异。治疗期间2组不良反应均为轻度,观察组头痛,关节酸痛的发生率(8.3%)稍低于对照组(14.6%),有显著性差异(P<0.05);便秘及皮疹的发生率无显著性差异。且期间未出现与止吐方案相关的严重不良反应。结论:阿瑞匹坦及托烷司琼联合地塞米松(第1天)的预防性止吐作用可实现与地塞米松(第1~3天)相似的疗效,特别是对于延迟性化疗相关性恶心呕吐疗效更佳,且安全性更好,值得临床推广。     

Aprepitant: a review of its use in the prevention of chemotherapy-induced nausea and vomiting

Aprepitant (Emend) is the first commercially available drug from a new class of agents, the neurokinin NK(1) receptor antagonists. Oral aprepitant, in combination with other agents, is indicated for the prevention of acute and delayed chemotherapy-induced nausea and vomiting (CINV) associated with highly emetogenic chemotherapy in adults.In three randomised, double-blind, placebo-controlled trials comparing aprepitant (125 mg day 1, 80mg once daily on days 2 and 3 or 2-5) plus standard therapy (intravenous ondansetron and oral dexamethasone) with standard therapy plus placebo, overall complete responses (primary endpoint, defined as no emesis and no rescue therapy) were seen in significantly more patients in the aprepitant arms (63-73% versus 43-52%, p < 0.01 for all comparisons).Complete responses and complete protection during the acute and delayed phase, and overall complete protection were also observed in significantly more patients in the aprepitant arms. The difference between treatment groups was more marked in the overall and delayed phases than in the acute phase.The antiemetic efficacy of aprepitant plus standard therapy in the prevention of CINV was maintained for up to six cycles of chemotherapy.Where assessed, more patients in the aprepitant plus standard therapy arms than the standard therapy plus placebo arms reported no impact of CINV on daily life, as assessed by the Functional Living Index-Emesis.Aprepitant is generally well tolerated. The most common adverse events in randomised trials were asthenia or fatigue. Other adverse events experienced by aprepitant recipients include anorexia, constipation, diarrhoea, nausea (after day 5 of the study) and hiccups. In addition to being a substrate for cytochrome P450 (CYP) 3A4, aprepitant is also a moderate inhibitor and inducer of this isoenzyme as well as an inducer of CYP2C9. Thus, aprepitant has the potential to interact with other agents metabolised by hepatic CYP isoenzymes. In one trial, there was a higher incidence of serious infection or febrile neutropenia in the aprepitant plus standard therapy arm than the standard therapy plus placebo arm; this was attributed to a pharmacokinetic interaction between aprepitant and dexamethasone. In subsequent trials, a modified dexamethasone regimen was used.In conclusion, when added to standard therapy (a serotonin 5-HT(3) receptor antagonist and a corticosteroid), aprepitant is effective and generally well tolerated in the prevention of CINV associated with highly emetogenic chemotherapy in adults. Despite marked advances in the prevention of CINV, standard therapy does not protect all patients. The addition of aprepitant to standard therapy provides an advance in the prevention of both acute and delayed CINV in adults with cancer.     

斛柏粉敷脐控制乳腺癌化疗所致恶心呕吐疗效观察

目的 观察斛柏粉敷脐控制乳腺癌化疗所致恶心呕吐的效果.方法 将89例经病理确诊乳腺癌术后接受化疗的患者随机分为观察组(n=45)和对照组(n=44).对照组于化疗前30 min静脉滴注3 mg格拉司琼止吐;观察组在应用格拉司琼的同时,于化疗前晚用备好的斛柏粉10 g外敷于神阙穴,每晚换药1次,至化疗结束后次晨停用.结果 观察组急性呕吐发生率为28.9％,明显低于对照组的52.3％(x2=5.050,P=0.025);迟发性呕吐发生率为15.6％,明显低于对照组的34.1％(x2=4.107,P=0.043).观察组食欲明显好于对照组,0～Ⅰ度发生率比较,差异有统计学意义(x2=8.217、4.047,P=0.004、0.044,);Ⅱ～Ⅲ度发生率比较,差异无统计学意义.结论 斛柏粉敷脐对乳腺癌化疗所致恶心呕吐有较好的控制效果.     

Influence of pharmaceutical care on the delayed emesis associated with chemotherapy

Background Complete control of emesis during chemotherapy remains to be achieved. This could be improved by increasing adherence to medicines and recommendations. Objective The aim of this study was to analyse the effects of pharmaceutical care on the incidence of delayed chemotherapy-induced nausea and vomiting (CINV) in adult cancer outpatients. Method This is a longitudinal prospective intervention study. Patients included were those who received a new cancer intravenous treatment. We compared complete response (no vomiting and no rescue treatment) and the incidence of nausea in the control group (CG) and in the intervention group (IG), as well as patients’ adherence. Pharmaceutical intervention consisted of: reviewing the antiemetic protocol and giving some recommendations to the patients. Results 102 patients were studied. In the delayed phase complete response was achieved in 84.8 % of the patients in the IG, compared with 69.6 % in the control group [absolute risk reduction (ARR), 15.2 %; p = 0.144]. Regarding absence of vomiting, the difference was higher (71.0 CG vs 97.0 % IG, ARR, 26.0%; p = 0.002). Absence of delayed nausea were also better in the IG (61 vs. 52 %). Compliant patients increased from 59 to 76 %. Conclusion The intervention of a pharmacist reduced the incidence of delayed CINV and improved medication adherence.     

Anti-emetic therapy in cancer chemotherapy: current status

Nausea and vomiting are ranked as the most severe side effects to chemotherapy by cancer patients. Twenty years ago, treatment of nausea and vomiting from chemotherapy only had moderate effect and often unpleasant side effects. The drugs used included dopamine(2)-receptor antagonists and corticosteroids alone or combined. This review summarizes the development of anti-emetic therapy, but will focus on the importance of two new classes of anti-emetics: the serotonin(3)- and the neurokinin(1)-receptor antagonists. Furthermore, evidence-based guidelines for the treatment of chemotherapy-induced nausea and vomiting will be given. The serotonin(3)-receptor antagonists, the first group of drugs developed specifically as anti-emetics, have significantly improved the prophylaxis of chemotherapy-induced emesis especially in combination with a corticosteroid. The improvement in the prophylaxis of nausea with this combination is however modest. A new group of anti-emetics, the neurokinin(1)-receptor antagonists, has now been developed, and the first drug, aprepitant, was marketed in 2003. Aprepitant increases the effect of a serotonin(3)-receptor antagonist plus a corticosteroid against acute emesis induced by highly or moderately emetogenic chemotherapy and aprepitant is also active in the protection against delayed emesis. The importance of drug-drug interactions with anti-emetics and other drugs, especially cytotoxins, through their competition for cytochrome P450 enzymes, have been studied. At present, there is no evidence that such interactions are of major clinical importance. Evidence-based clinical guidelines are now available and regularly updated, but unfortunately clinical implementation is slow. Recommendations for some types of chemotherapy-induced emesis such as delayed emesis, is based on a low level of evidence. Furthermore, the majority of clinical trials include highly selected groups of patients not permitting definite conclusions for other and more heterogeneous patient groups. Development of new anti-emetics with other mechanisms of action is awaited with interest.     

Cancer chemotherapy-induced nausea and vomiting: role of mediators, development of drugs and treatment methods

The development of serotonin 5-HT3 receptor antagonists dramatically improved the treatment of chemotherapy-induced nausea and vomiting. Ondansetron, a serotonin 5-HT3 receptor antagonist in combination with dexamethasone is widely used to treat chemotherapy-induced nausea and vomiting. This treatment regimen is effective against acute nausea and vomiting, but fails to control delayed nausea and vomiting. Metoclopramide along with other antiemetics are used to treat delayed nausea and vomiting. The high doses of metoclopramide needed may produce extra pyramidal side effects. The recent developments of 5-HT3 and dopamine D2 dual receptor antagonists have been found to exhibit a broad spectrum of activity against peripherally and centrally acting stimuli, but are not much effective against delayed emesis associated with chemotherapy. In various animal models, neurokinin NK1 receptor antagonists showed promising results against acute and delayed emesis, but the clinical trials revealed that triple therapy (NK1 receptor antagonist, 5-HT3 receptor antagonist and dexamethasone) is superior than standard therapy (5-HT3 receptor antagonist & dexamethasone) or NK1 receptor antagonist alone, in controlling acute as well as delayed nausea and vomiting. Ginger, which is used traditionally for controlling emesis induced by various stimuli, also showed good activity against chemotherapy-induced nausea and vomiting in animal models. Non-pharmacological methods such as acupressure and acustimulation are good adjunct methods in treating nausea and vomiting. Since many mediators are involved in emesis induced by chemotherapy, cocktail treatment is proven to be more efficacious than a single drug, but increases treatment costs. So there is a need of further research in this field to get economically useful methods for the treatment of acute and delayed chemotherapy-induced nausea and vomiting.     

Tropisetron: an update of its use in the prevention of chemotherapy-induced nausea and vomiting

Tropisetron is a serotonin (5-hydroxytryptamine; 5-HT) antagonist that is primarily used in the prevention of chemotherapy-induced nausea and vomiting. Antagonism of 5-HT3 binding sites in the peripheral and central nervous system is the probable mechanism of prevention of acute nausea and vomiting. Effects on delayed nausea and vomiting are less well understood as these are probably not mediated solely by 5-HT3 receptors. Tropisetron monotherapy is effective for the control of acute, and to a lesser extent delayed, nausea and vomiting in patients receiving moderately to severely emetogenic chemotherapy. The combination of dexamethasone and tropisetron is more effective than monotherapy. Complete control of cisplatin-induced nausea and vomiting was obtained in 69 to 97% of patients receiving the combination compared with 46 to 80% receiving tropisetron monotherapy in randomised trials. There were generally no significant differences between the control of acute or delayed nausea and vomiting provided by tropisetron, ondansetron or granisetron in randomised, comparative trials. The antiemetic efficacy of tropisetron was maintained over multiple cycles of chemotherapy. Most comparative studies showed tropisetron monotherapy to be more effective than metoclopramide in controlling acute nausea and vomiting, with the exception of 1 study which showed similar efficacy. However, high dose metoclopramide plus dexamethasone provided similar control of delayed emesis to tropisetron plus dexamethasone. Tropisetron is also effective in children, including those who responded poorly to previous antiemetic treatment. Tropisetron and ondansetron generally have similar efficacies in this population. The drug enhanced patients' quality of life and was well tolerated by adults and children alike. The recommended oral and IV dosage of tropisetron is 5 mg once daily; there is no increase in efficacy with doses >5 mg. CONCLUSIONS: Tropisetron is similar to other 5-HT3 receptor antagonists for the prevention of chemotherapy-induced nausea and vomiting in both adults and children. It is suitable as first-line therapy (combined with a corticosteroid) for the prevention of acute nausea and vomiting in patients treated with moderately to severely emetogenic chemotherapeutic agents. This combination is also moderately effective in the prevention of delayed nausea and vomiting.     

地西泮预防化学治疗诱导的恶心呕吐75例

目的探讨苯二氮革类药物地西泮联合格拉司琼、地塞米松预防化学治疗诱导的恶心呕吐的疗效和安全性。方法将150例接受化学治疗的肿瘤患者随机分成两组,各75例,对照组采用标准止吐方案格拉司琼联合地塞米松,试验组在对照组基础上加用地西泮,观察两组急性、延迟性和总的恶心呕吐缓解率,并评价治疗期间的毒副反应。结果完全缓解试验组53例（71.62%）,对照组42例（57.53%）,两组比较,X~2=3.19,P〉0.05;急性恶心呕吐缓解试验组57例（77.03%）,对照组55例（75.34%）,两组比较,X~2=0.06,P〉0.05;延迟性恶心呕吐缓解试验组55例（75.68%）,对照组缓解43例（58.90%）,两组比较,X~2=3.93,P〈0.05。两组各项毒副反应无显著性差异（P〉0.05）。结论在应用格拉司琼、地塞米松基础上加用地西泮,可更好地控制化学治疗诱导的延迟性恶心呕吐,提高患者生活质量,值得临床推广。