Aprepitant versus Olanzapine for Prevention of Nausea and Vomiting Induced by Multi-day Chemotherapy in Female Lung Cancer or Breast Cancer Patients
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摘要:目的
评估阿瑞匹坦/奥氮平联合托烷司琼和地塞米松方案在多日顺铂化疗的女性患者中的有效性、安全性和费用效益比。
方法采用随机对照研究方法，将87例女性肿瘤患者随机分为阿瑞匹坦组（44例）和奥氮平组（43例）。阿瑞匹坦组止吐方案：阿瑞匹坦、托烷司琼和地塞米松；对照组方案：奥氮平、托烷司琼和地塞米松。
结果44例阿瑞匹坦组患者中，29例患者（65.9%）延迟期呕吐达到完全缓解，43例患奥氮平组患者中，30例（69.8%）延迟期呕吐达到完全缓解，两组比较差异无统计学意义（P=0.690）。阿瑞匹坦组呃逆发生率更高（P=0.023），其余不良反应两组差异无统计学意义；而奥氮平导致的嗜睡作用更明显（P=0.006）。血液学毒性方面两组之间差异无统计学意义。每周期阿瑞匹坦组的费用明显高于奥氮平组（P < 0.01）。
结论奥氮平联合托烷司琼和地塞米松用于女性肺癌和乳腺癌患者多日化疗所致的延迟性恶心呕吐安全性和有效性与阿瑞匹坦联合托烷司琼和地塞米松相似，但更具有费用效益比优势。
Abstract:ObjectiveTo compare the effectiveness, safety and cost-effectiveness ratio between Olanzapine (OLN) and Aprepitant (APR) for the prevention of chemotherapy-induced nausea and vomiting (CINV) in female patients who received multi-day cisplatin-based chemotherapy.
MethodsEighty-seven female patients were randomized to receive Aprepitant (44 cases) or Olanzapine (43 cases). Antiemetic regimen received by Aprepitant group and olzanpine group were as follows. Aprepitant group: Aprepitant, Tropisetron and Dexamethasone; Olanzapine group: Olanzapine, Tropisetron and Dexamethasone.
ResultsNo substantial difference was found in complete response rate of delayed emesis in Aprepitant group (29/44) and in Olanzapine group (30/43), (65.9% vs. 69.8%, P=0.690). Higher hiccup incidence was found in Aprepitant group (31.8%, P=0.023) while a more pronounced drowsiness effect was observed in Olanzapine group (25.6%, P=0.006). Hematological toxicity between the two groups was of no significant difference. Yet, the cost of Aprepitant group per cycle was much higher than that of Olanzapine group (P < 0.01).
ConclusionIn female lung and breast cancer patients, the safety and effectiveness of Aprepitant combined with Dexamethasone and Tropisetron are similar to those of Olanzapine regarding delayed nausea and vomiting induced by 3 days Cisplatin chemotherapy, but the latter is more cost-effective.
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Key words:
- Aprepitant /
- Olanzapine /
- Cisplatin /
- Chemotherapy /
- Chemotherapy-induced nausea and vomiting
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表 2 两组患者CINV完全缓解率和恶心缓解率的比较 (n(%))
Table 2 Comparison of complete response rate of CINV and remission rate of nausea between two groups (n(%))
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[1] Yuan DM, Li Q, Zhang Q, et al.Efficacy and Safety of Neurokinin-1 Receptor Antagonists for Prevention of Chemotherapy-Induced Nausea and Vomiting: Systematic Review and Meta-analysis of Randomized Controlled Trials[J].Asian Pac J Cancer Prev, 2016, 17(4): 1661-75. doi: 10.7314/APJCP.2016.17.4.1661
[2] 董爽, 于世英.肿瘤化疗所致恶心呕吐现状调查[J].中国循证医学杂志, 2013, 13(6): 687-91. doi: 10.7507/1672-2531.20130122 Dong S, Yu SY.Status survey on chemotherapy-induced nausea and vomiting[J].Zhongguo Xun Zheng Yi Xue Za Zhi, 2013, 13(6): 687-91. doi: 10.7507/1672-2531.20130122
[3] Navari RM, Aapro M.Antiemetic Prophylaxis for Chemotherapy-Induced Nausea and Vomiting[J].N Engl J Med, 2016, 374(14): 1356-67. doi: 10.1056/NEJMra1515442
[4] Grunberg SM, Dugan M, Muss H, et al.Effectiveness of a single-day three-drug regimen of dexamethasone, palonosetron, and aprepitant for the prevention of acute and delayed nausea and vomiting caused by moderately emetogenic chemotherapy[J].Support Care Cancer, 2009, 17(5): 589-94. doi: 10.1007/s00520-008-0535-9
[5] Multinational Association of Supportive Care in Cancer.A Mascc/Esmo Antiemetic Guideline Version 1.2 2016[EB/OL].[2016-03-26].http://www.mascc.org/assets/Guidelines-Tools/masccantiemetic guidelines English 2016 v.1.2.pdf.
[6] NCCN.Clinical Practice Guidelines in Oncology: antiemesis Version 2.2016 [EB/OL].[2016-04-15].https://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf.
[7] DeRemer DL, Clemmons AB, Orr J, et al.Emerging role of olanzapine for prevention and treatmentof chemotherapy-induced nauseaand vomiting[J].Pharmacotherapy, 2016, 36(2): 218-29. doi: 10.1002/phar.2016.36.issue-2
[8] Navari RM, Nagy CK, Gray SE.The use of olanzapine versus metoclopramide for the treatment of breakthrough chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy[J].Support Care Cancer, 2013, 21(6): 1655-63. doi: 10.1007/s00520-012-1710-6
[9] Roscoe JA, Heckler CE, Morrow GR, et al.Prevention of delayed nausea: a University of Rochester Cancer Center Community Clinical Oncology Program study of patients receiving chemotherapy[J].J Clin Oncol, 2012, 30(27): 3389-95. doi: 10.1200/JCO.2011.39.8123
[10] Hesketh PJ.Chemotherapy-induced nausea and vomiting[J].N Engl J Med, 2008, 358(23): 2482-94. doi: 10.1056/NEJMra0706547
[11] Fernández-Ortega P, Caloto MT, Chirveches E, et al.Chemotherapy-induced nausea and vomiting in clinical practice: impact on patients' quality of life[J].Support Care Cancer, 2012, 20(12): 3141-8. doi: 10.1007/s00520-012-1448-1
[12] Gao HF, Liang Y, Zhou NN, et al.Aprepitant plus palonosetron and dexamethasone for prevention of chemotherapy-induced nausea and vomiting in patients receiving multiple-day cisplatin chemotherapy[J].Intern Med J, 2013, 43(1): 73-6. doi: 10.1111/j.1445-5994.2011.02637.x
[13] Olver IN, Grimison P, Chatfield M, et al.Results of a 7-day aprepitant schedule for the prevention of nausea and vomiting in 5-day cisplatin-based germ cell tumor chemotherapy[J].Support Care Cancer, 2013, 21(6): 1561-8. doi: 10.1007/s00520-012-1696-0
[14] Gralla RJ.Palliative care: Aprepitant and control of emesis induced by 5-day chemotherapy[J].Nat Rev Clin Oncol, 2012, 9(11): 614-6. doi: 10.1038/nrclinonc.2012.183
[15] Albany C, Brames MJ, Fausel C, et al.Randomized, double-blind, placebo-controlled, phase iii cross-over study evaluating the oral neurokinin-1 antagonist and dexamethasone in patients with germ cell tumors receiving 5-day cisplatin combination chemotherapy regimens: a hoosier oncology group study[J].J Clin Oncol, 2012, 30(32): 3998-4003. doi: 10.1200/JCO.2011.39.5558
[16] Navari RM, Gray SE, Kerr AC.Olanzapine versus aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a randomized phase Ⅲ trial[J].J Support Oncol, 2011, 9(5): 188-95. doi: 10.1016/j.suponc.2011.05.002
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