国产格拉司琼预防大剂量顺铂化疗所致呕吐的临床观察

观察格拉司琼的止吐疗效和毒性。方法：对１００例接受大剂量顺铂化疗的患者,采用随机抽样的方法,比较国产格拉司琼和进口拉格司琼在相等剂量下的疗效和毒性。结果：格拉司琼能有效地预防大剂量顺铂化疗引起的恶心、呕吐、其止吐效果与Ｇｒａｎｉｓｅｔｒｏｎ康泉相同。两药的止吐效果分别为９０％和９２％,完全缓解率分别为８２％和８４％。两药的疗产无显著差异,并且不良反应小。结论：格拉司琼为肿瘤化疗安全有效的止吐药,且     

帕洛诺司琼预防高致吐性化疗所致恶心呕吐临床研究

目的:通过帕洛诺司琼和格拉司琼分别联合地塞米松预防以大剂量顺铂为主方案化疗所致恶心呕吐,观察和评价帕洛诺司琼联合地塞米松预防高致吐性化疗方案的疗效和安全性.方法:56例非小细胞肺癌患者接受以大剂量顺铂为主化疗方案,随机分为两组:治疗组28例,对照组28例.治疗组:帕洛诺司琼0.25 mg,静脉推注;对照组:格拉司琼3 mg,静脉滴注;两组均联合地塞米松12 mg,静脉推注,均于化疗前30min给药.结果:治疗组和对照组预防急性呕吐的完全有效率分别为82.1%和78.6%,恶心的改善率分别为64.3%和60.7%,差异均无显著性(P>0.05);治疗组和对照组预防延迟性呕吐的完全有效率分别为60.7%和39.3%,差异有显著性(P<0.05).结论:帕洛诺司琼和格拉司琼分别联合地塞米松预防以大剂量顺铂为主方案化疗所致急性呕吐和恶心疗效相当,对于延迟性呕吐的完全有效率前者优于后者,不良反应轻,患者耐受性良好,推荐帕洛诺司琼联合地塞米松作为高致吐性化疗方案的常规药物.     

不同给药时间口服格拉司琼止吐效果观察

目的观察肿瘤患者化疗期间口服格拉司琼不同给药时间的止吐效果。方法 40例患者随机分两组,采用自身对照试验法每组观察2个疗程时间。第1疗程两组分别于化疗前晚或者化疗当日晨口服1次格拉司琼预防呕吐,在第2疗程两组交换服药方法,观察记录止吐情况。结果第1组化疗前日晚始每晚服格拉司琼片3d内止吐有效率分别为85.3%、82.3%、81.0%,明显低于下一疗程的对照93.0%、92.7%、90.3%(P<0.05);第2组化疗当日晨口服格拉司琼分散片3d内止吐有效率分别为87.8%、86.3%、83.6%,下疗程的对照为86.1%、84.3%、81.5%(P<0.05)。结论化疗当日始每日晨口服1次格拉司琼片止吐效果优于化疗前日每晚口服1次格拉司琼片。     

格拉司琼加地塞米松预防含顺铂化疗所致恶心呕吐的临床观察

目的:观察格拉司琼与地塞米松联用预防含顺铂的联合化疗所致的恶心、呕吐及其他不良反应,并与单用格拉司琼比较.方法:采用随机、交叉、自身对照法,将40例接受含顺铂80 mg/(m2·d)的联合化疗的恶性肿瘤患者,随机分为A、B两组.A组第1周期用格拉司琼,第2周期用格拉司琼加地塞米松;B组第1周期用格拉司琼加地塞米松,第2周期用格拉司琼.止吐方案:格拉司琼3 mg,静注,第1～3天,地塞米松10 mg,静注,第1～3天.结果:格拉司琼加地塞米松(联合组)第1～6天无恶心和轻度恶心的发生率均高于单用格拉司琼(单用组),其中第1～4和第6天差异有显著性(P＜0.05).联合组第1～6天呕吐完全控制率和有效控制率均高于单用组,其中第2、3天差异有显著性(P＜0.05).结论:地塞米松能增强格拉司琼对含顺铂化疗所致的恶心、呕吐的控制,可作为预防和控制含顺铂联合化疗所致恶心、呕吐的理想用药,值得临床推广.     

盐酸格拉司琼联合胃复安预防化疗呕吐的观察

我院2004—07-2006—05对经病理诊断为恶性实体瘤的患者行含顺铂化疗，给予格拉司琼加胃复安止吐治疗，疗效良好。现报道如下。     

生姜联合昂丹司琼预防化疗患者呕吐的疗效观察

化疗是肿瘤患者重要的治疗方法,化疗过程常引起恶心、呕吐等不良反应,特别是大剂量阿糖胞苷、柔红霉素、顺铂等高致吐药可引起频繁呕吐,使患者水及电解质平衡紊乱,延缓化疗药物清除及增加化疗药物毒性,患者常对化疗产生畏惧,甚至拒绝化疗。临床发现采用昂丹司琼止吐,部分患者效果较差。2006年12月至2007年12月,本院肿瘤科对60例肿瘤化疗患者用生姜联合昂丹司琼预防化疗引起的呕吐,效果较满意,现报告如下。     

地塞米松在预防乳腺癌蒽环类化疗致呕吐的效果

目的:观察地塞米松在预防乳腺癌蒽环类化疗所致消化道反应中的疗效.方法:对129例接受以蒽环类联合化疗的乳腺癌患者,随机分成两组,A组接受化疗前给予格拉司琼针3 mg静推及地塞米松针5 mg静推,B组接受化疗前给予格拉司琼针3mg静推,观察两组48h内消化道反应情况.结果:两组的恶心、呕吐有效控制率分别为84.1%和66.7%(P<0.05).结论:地塞米松联合格拉司琼可以有效减少乳腺癌术后蒽环类化疗所致呕吐发生,是一种疗效高、价格低廉、安全有效的止吐方法.     

格拉司琼预防高剂量顺铂联合化疗所致呕吐

顺铂抗癌谱广,疗效可靠,临床应用广泛,但其所致的严重胃肠道反应(恶心、呕吐)使病人难以耐受化疗,以往用胃复安等止吐效果差,且有明显锥体外系症状。近十余年来临床广泛使用半衰期长和高选择性的5-HT3受体拮抗剂格拉司琼等,能有效控制肿瘤患者化疗引起的恶心呕吐。我们应用格拉     

电子止吐仪联合盐酸阿扎司琼防治奈达铂化疗所致恶心、呕吐的疗效观察

[目的]探讨电子止吐仪联合盐酸阿扎司琼防治奈达铂化疗所致恶心、呕吐的临床疗效。[方法]将160例接受奈达铂化疗的病人随机分为试验组和对照组各80例。试验组应用电子止吐仪联合盐酸阿扎司琼止吐,对照组单用盐酸阿扎司琼止吐,记录两组病人化疗开始到化疗后第7天恶心、呕吐以及其他不良反应的发生情况。[结果]试验组病人呕吐的完全控制率和有效率分别为72.50%,93.75%,对照组为53.75%,81.25%;试验组恶心完全控制率和有效率分别为65.00%,91.25%,对照组为42.50%,77.50%,两组呕吐、恶心的完全控制率和有效率比较差异均有统计学意义(P0.05)。两组头晕、口渴、便秘等不良反应发生率比较差异无统计学意义(P0.05)。[结论]电子止吐仪与盐酸阿扎司琼联合用于预防奈达铂化疗所致呕吐、恶心效果优于单用盐酸阿扎司琼。     

应用大剂量顺铂化疗的护理

自1969年发现顺铂 (PDD) 的抗癌作用以来,进行了大量的临床及药理学研究,本药被认为是广谱抗癌药物,已广泛应用于临床。但因其肾毒性及胃肠道反应等副作用,限制了剂量的加大,影响了疗效。为此,我科采用大剂量顺铂(100mg/m~2)治疗前后水化以及联合应用止吐剂,使其肾毒性及胃肠道反应降低,提高了顺铂大剂量应用的安全性,效果尚属满意。     

盐酸托烷司琼胶囊防治化疗所致恶心呕吐的临床研究

目的:观察国产盐酸托烷司琼胶囊预防化疗所致恶心呕吐的临床疗效和安全性,同时选用格拉司琼胶囊作对照组进行分析。方法:24例均接受含顺铂或阿霉素或吡喃阿霉素的联合化疗者随机分为两组,采用双盲法随机双交叉设计,于每组化疗两个周期中交叉用药。观察第1~8天患者恶心、呕吐控制的有效率及药物不良反应。结果:国产盐酸托烷司琼胶囊和国产盐酸格拉司琼胶囊在治疗化疗药引起的恶心、呕吐反应以及安全性指标检测均无显著性差异(P>0.05)。结论:国产盐酸托烷司琼胶囊治疗化疗药所引起的恶心、呕吐反应的疗效和用药安全性与国产盐酸格拉司琼胶囊相当。     

Efficacy and safety of different doses of granisetron for the prophylaxis of cisplatin-induced emesis

The purpose of this study was to evaluate the efficacy and safety of four different doses of granisetron when administered as a single intravenous (i.v.) dose for prophylaxis of cisplatin-induced emesis in a multicenter, randomized, parallel-group, double-blind investigation. A total of 353 chemotherapy-naive patients were enrolled, stratified according to cisplatin dose (moderate dose: 50–80 mg/m²,n = 169; high dose: 81–120 mg/m²,n = 184) and randomized to one of four granisetron doses: 5, 10, 20, or 40 µ/kg. Control of emesis was evaluated by the percentages of patients attainingcomplete response (no vomiting or retching, and no rescue medication) andmajor response (2 episodes of vomiting or retching, and no rescue medication). Patients were assessed on an inpatient basis for 18–24 h. Safety analyses consisted of adverse events and laboratory parameter changes. Complete response rates over 24 h after chemotherapy were 23%, 48%, 48%, and 44% for granisetron doses of 5, 10, 20, and 40 µg/kg, respectively, in the combined patient population (P=0.011 for linear trend); 29%, 56%, 58%, and 41%, respectively, in the moderate-dose cisplatin stratum (P=0.278 for linear trend); and 18%, 41%, 40%, and 47%, respectively, in the high-dose cisplatin stratum (P = 0.011 for linear trend). Transient headache was the most frequently reported adverse event (19%). There was no evidence of association between increased dose and headache. A single 10-, 20- or 40-µg/kg dose of granisetron is comparably effective in controlling nausea and vomiting associated with moderateor high-dose cisplatin chemotherapy. Granisetron was safe and well tolerated at all doses.     

Gender discrepancy observed between chemotherapy-induced emesis and hiccups

The aim of this paper was to describe striking gender differences observed between emesis and hiccups in patients receiving cisplatin-based chemotherapy (CT) and one of two dexamethasone-containing anti-emetic regimens. Four hundred patients were evaluated in a crossover study with two arms. Patients in arm A received three doses of ondansetron 8 mg i.v. at 4-h intervals plus dexamethasone 20 mg i.v. from the start of CT, followed by dexamethasone 5 mg i.v. every 12 h, until CT was complete, after which dexamethasone was discontinued. For patients in arm B the treatment was the same as in arm A except that the three doses of ondansetron 8 mg i.v. were given at 24-h intervals. There were 363 patients in arm A and 358 patients in arm B. Vomiting/nausea/hiccups were observed in 30.3%/41.6%/23.7% of patients in arm A and 28.8%/39.1%/23.7% of patients in arm B, respectively. Comparison showed that the rates for complete control of vomiting and nausea on days 1 through 6 were significantly lower in women (P<0.0001 and =0.0004 in arm A and P<0.0001 and <0.0001 in arm B, respectively). Men had a significantly higher incidence of hiccups (P<0.0001 in both arms), but no apparent associations with age, cisplatin dose, tumor type, and the presence of vomiting and nausea during CT were found. Hiccups usually began 24 h after cisplatin administration and persisted for some days. Women had significantly higher rates of vomiting and nausea. The cause of the gender discrepancy is unknown.     

紫杉醇单周给药联合顺铂治疗30例晚期非小细胞肺癌观察

目的:评价紫杉醇单周给药联合顺铂化疗治疗晚期非小细胞肺癌的临床疗效和不良反应。方法:30例晚期非小细胞肺癌患者采用紫杉醇75mg/m2,d1、d8、d15,使用顺铂20mg/m2,d2￣d6。3周为1个周期,均治疗2个周期。结果:30例晚期非小细胞肺癌中,部分缓解13例,稳定10例,进展7例,总有效率43.3%。主要毒副反应为恶心呕吐、骨髓抑制、肌肉及关节疼痛、周围神经炎、肝肾功能轻度损害。结论:紫杉醇单周给药联合顺铂治疗非小细胞肺癌具有较好的疗效,毒副作用可以耐受。     

A pilot trial of combination cisplatin, 5-fluorouracil and interferon-alpha in the treatment of advanced esophageal carcinoma

BACKGROUND/OBJECTIVES: Based on the synergistic effect between cisplatin and 5-fluorouracil (5-FU), and between 5-FU and interferon-alpha, we conducted a trial to assess the response rate and toxicity of the combination of cisplatin, 5-FU and interferon-alpha in patients with advanced esophageal cancer. METHODS: Patients with locally advanced or metastatic squamous cell or adenocarcinoma of the esophagus were eligible. No prior chemotherapy or interferon were allowed. Patients received cisplatin 80 mg/m(2) on day 1, 5-FU 750 mg/m(2)/day by continuous intravenous infusion for 5 days, and interferon-alpha 5 x 10(6) units/m(2)/day by subcutaneous injection on days 1-5 of each cycle. Cycles were repeated every 21 days for a total of 6 cycles. RESULTS: Forty patients were enrolled. Median age was 57.5 years (range 30-70). 33 had squamous carcinoma and 7 adenocarcinoma; 15 were male; the locoregional metastatic ratio was 1:39; median ECOG performance status was 2 (range 1-3). Grade 3-4 toxicities were: leukopenia (9 cases), thrombocytopenia (4), electrolyte imbalance (11), febrile neutropenia (11), vomiting (5), diarrhea (4), and mucositis (11). There were 3 early deaths, most probably related to therapy. Five patients (13%) achieved a complete response and 17 (42%) achieved a partial response, yielding an overall response rate of 55%. Response rates for squamous and adeno histology were 61% and 29%, respectively. Median survival was 6.4 months. CONCLUSION: The combination of cisplatin, 5-FU and interferon-alpha produces a high response rate in advanced squamous cell esophageal carcinoma, but with considerable toxicity. A modified combination of the above agents is presently being evaluated at our institution.     

Single high-dose dexamethasone improves the effect of ondansetron on acute chemotherapy-induced nausea and vomiting but impairs the control of delayed symptoms

The introduction of serotonin receptor (5-HT₃) antagonists has improved the control of acute nausea and vomiting induced by cancer chemotherapy, but they seem to have little or no effect on delayed symptoms. Corticosteroids are known to reduce both acute and delayed nausea and vomiting. The aim of the present study was to test the hypothesis that a single high dose of dexamethasone (20 mg), a long-acting corticosteroid, given after cisplatin and in addition to ondansetron (8 mg three times a day), would enhance the control of both acute and delayed nausea and vomiting. A group of 104 chemotherapy-naive ovarian cancer patients, scheduled for at least three cycles of combination chemotherapy including cisplatin (50 mg/m₂), were randomly allocated to receive either dexamethasone or placebo in addition to ondansetron. Two-thirds of the patients received doxorubin and melphalan on the day before cisplatin and 1/3 received doxorubicin immediately before cisplatin. Unexpectedly we found, in all three chemotherapy cycles, that patients receiving dexamethasone suffered from more delayed nausea and vomiting than patients receiving placebo. In patients with no acute nausea or vomiting, the boomerang effect of dexamethasone could be seen on the first day after chemotherapy. In a follow-up study on 5 patients not included in the randomized trial, dexamethasone induced a pronounced reduction in urinary cortisol excretion on the day after chemotherapy with a return to normal excretion on day 2. It is concluded that a single high dose of dexamethasone does not seem appropriate for controlling delayed nausea and vomiting.     

长春瑞滨联合顺铂治疗晚期非小细胞肺癌疗效观察

目的:观察长春瑞滨(盖诺)联合顺铂(NP方案)治疗晚期非小细胞肺癌(NSCLC)的疗效及毒副作用。方法:42例经病理或细胞学诊断为非小细胞肺癌患者,采用国产长春瑞滨25mg/m2,第1、8天静滴;顺铂(DDP)60～80mg/m2,第1～3天静滴,28d为1个周期。结果:CR3例,PR15例,SD16例,PD8例,总有效率(CR+PR)为42.9%。主要毒副反应为白细胞减少及胃肠反应。结论:长春瑞滨联合顺铂治疗晚期NSCLC疗效确切,毒副反应可耐受。     

Nausea and vomiting

Nausea and vomiting are the most distressing side effects reported by patients undergoing CDDP-based cancer chemotherapy. Dopamine receptor antagonists and corticosteroids are used as anti-emetics for chemotherapy induced nausea and vomiting. Recently, a highly selective 5-HT3 receptor antagonist are proved to demonstrate antiemetic activity. 5-HT3 receptor antagonists are developed such as Granisetron, Ondansetron, Ramosetron, Azasetron. For acute emesis, complete control of vomiting was achieved in 80% of patients receiving 5-HT3 receptor antagonists. Though, it is reported to be only 20% effective for the complete control of delayed emesis. Psychiatric medications sometimes play a prominent role in the control of persisting emesis, particularly anticipatory or conditioned nausea. Nausea and vomiting are well controlled using various anti-emetics considering patient's condition and chemotherapy schedule.     

A dose-finding study of granisetron,a novel antiemetic,in patients receiving high-dose cisplatin

In this double-blind study, the efficacy and safety of a single intravenous dose of a novel antiemetic, granisetron, was assessed at two dose levels (40 g/kg and 160 g/kg). A group of 355 patients were given prophylactic granisetron prior to receiving highdose cisplatin chemotherapy. In the first 24 h, 57% and 59% of patients, respectively, experienced no vomiting and no more than mild nausea. Two further doses of granisetron (40 g/kg) were permitted in the first 24 h to treat any emergent symptoms of nausea and vomiting; 66 patients (39%) in the 40-g/kg treatment group and 56 patients (34%) in the 160-g/kg group received at least one additional dose. Additional treatment with granisetron resulted in resolution or improvement of symptoms in at least 73% of these patients. Over the 7-day study period, 52% of patients in the lower-dose group and 48% in the higher required no further conventional antiemetic therapy. The two different dose levels were equal both in terms in efficacy and safety. Granisetron was well tolerated throughout the dose range of the study [40–240 g kg^-1 (24 h)^-1]. The commonest adverse event was headache, seen in 14%–16% of patients. In all but one case this resolved spontaneously or responded to simple treatment.on behalf of the Granisetron Study Group