5-Hydroxytryptamine-3 receptor antagonist and dexamethasone as prophylaxis for chemotherapy-induced nausea and vomiting during moderately emetic chemotherapy for solid tumors: a multicenter, prospective, observational study

BMC Pharmacology and Toxicology

Satoru Shimizu¹  Mototsugu Shimokawa²  Hiroyasu Kaneda³  Toshinobu Hayashi⁴  Tomomi Takiguchi⁵  Kenichi Suzuki⁶  Tomohiko Harada⁷  Kimiko Fujiwara⁸  Reiko Matsui⁹  Takeshi Koike⁹  Yuki Kogure^1,10  Masashi Kimura^1,11  Makoto Nishio^1,12  Takashi Seto^1,13  Koichi Goto^1,14  Naoyuki Nogami^1,15  Hirotsugu Kenmotsu^1,16 

[1] Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, 241-0815, Yokohama-shi, Kanagawa, Japan;Department of Cancer Biostatistics Laboratory, Clinical Research Institute, National Hospital Organization, Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, 811-1395, Fukuoka, Japan;Department of Medical Oncology, Kindai University Hospital, 377-2 Ohno-higashi, Osaka-Sayama, 589-8511, Osaka, Japan;Department of Clinical Oncology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, 545-8585, Osaka, Japan;Department of Pharmacy, Clinical Research Institute, National Hospital Organization, Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, 811-1395, Fukuoka, Japan;Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, 814-0180, Fukuoka, Japan;Department of Pharmacy, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan;Department of Pharmacy, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan;Hoshi University Division of Applied Pharmaceutical Education and Research, 2-4-41 Ebara, Shinagawa-Ku, 142-8501, Tokyo, Japan;Department of Pharmacy, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, 241-0815, Yokohama-shi, Kanagawa, Japan;Department of Pharmacy, Kindai University Hospital, 377-2 Ohno-higashi, Osaka-Sayama, 589-8511, Osaka, Japan;Department of Pharmacy, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-shi, 277-8577, Chiba, Japan;Department of Pharmacy, National Hospital Organization, Shikoku Cancer Center, 160, Minamiumemoto-machi-kou, 791-0280, Matsuyama-city, Ehime, Japan;Department of Pharmacy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, 411-8777, Shizuoka, Japan;Department of Thoracic Medical Oncology, Japanese Foundation for Cancer Research, Cancer Institute Hospital, 3-8-31, Ariake, Koto, 135-8550, Tokyo, Japan;Department of Thoracic Oncology, Clinical Research Institute, National Hospital Organization, Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, 811-1395, Fukuoka, Japan;Department of Thoracic Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-shi, 277-8577, Chiba, Japan;Department of Thoracic Oncology, National Hospital Organization, Shikoku Cancer Center, 160, Minamiumemoto-machi-kou, 791-0280, Matsuyama-city, Ehime, Japan;Division of Thoracic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, 411-8777, Shizuoka, Japan;

关键词: Antiemetic therapy;    Chemotherapy-induced nausea and vomiting (CINV);    Moderate emetic risk chemotherapy (MEC);    NK-1 receptor antagonist;    5-HT3 receptor antagonist;   

DOI  :  10.1186/s40360-020-00445-y

来源: Springer

【 摘 要 】

BackgroundOf patients receiving moderate emetic risk chemotherapy (MEC), 30–90% experience chemotherapy-induced nausea and vomiting (CINV); however, the optimal antiemetic treatment remains controversial.MethodsIn this multicenter, prospective, observational study of adults treated with MEC while receiving chemotherapy for various cancer types in Japan, the enrolled patients kept diaries documenting CINV. All participants received a 5-hydroxytryptamine-3 receptor antagonist and dexamethasone.ResultsOf the 400 patients enrolled from May 2013 to January 2015, 386 were eligible for evaluation. The median age was 64 (range, 26–84). The overall complete response (CR; no emetic events and no antiemetic measures) rate was 64%. The proportion of patients showing CR was low in the carboplatin (CBDCA)- and oxaliplatin-based chemotherapy groups, especially among women. We showed that the CR rates in men were high in the CBDCA (AUC5) + etoposide (ETP) (80%), capecitabine plus oxaliplatin (CAPOX) (78%), and CBDCA+ paclitaxel (PTX) groups for lung cancer (73%). Total control (TC; no emetic events, no antiemetic measures, and no nausea) and complete control (CC; no emetic events, no antiemetic measures, and less than mild nausea) were achieved in 51 and 61% of patients, respectively. Logistic regression analysis revealed history of motion sickness, history of pregnancy-associated vomiting and CBDCA-based chemotherapy as risk factors for CR and history of motion sickness and history of pregnancy-associated vomiting as risk factors for TC. Additional, Ages ≥65 years is an independent predictive factor for achieving TC.ConclusionsOur data showed that two antiemetics were insufficient to control CINV in patients receiving CBDCA- or oxaliplatin-based chemotherapy. However, two antiemetics may be sufficiently effective for elderly male patients receiving CBDCA (AUC5) + ETP, CBDCA+PTX for lung cancer, or CAPOX. Additionally, we consider that three antiemetics are necessary for women with colorectal cancer receiving CAPOX. Risk factor analysis related to CR showed that CINV prophylaxis in patients treated with CBDCA-based chemotherapy was generally supportive of the guideline-recommended three antiemetics. However, the control of nausea in patients receiving non-CBDCA-based chemotherapy is a key point to note. The further individualization of antiemetic regimens for patients receiving MEC based on both types of chemotherapy regimens and sex is needed.

【 授权许可】

CC BY