福沙匹坦预防中重度致吐性方案所致化疗相关性呕吐的临床研究-现代医学

福沙匹坦预防中重度致吐性方案所致化疗相关性呕吐的临床研究

单位：1. 南京中医药大学附属南京医院/南京市第二医院药学部, 江苏南京 210003;
2. 南京医科大学附属肿瘤医院/江苏省肿瘤医院/江苏省肿瘤防治所放射治疗科, 江苏南京 210009;
3. 南京医科大学附属肿瘤医院/江苏省肿瘤医院/江苏省肿瘤防治所肿瘤内科, 江苏南京 210009

关键词：福沙匹坦中重度致吐性化疗方案化疗相关性呕吐

分类号：R730.5

出版年·卷·期（页码）：2022·50·第十期（1269-1274）

摘要：

目的：观察福沙匹坦预防中重度致吐性方案所致化疗相关性呕吐（CINV）的疗效。方法：选择2020年1月至2020年12月在江苏省肿瘤医院接受中重度致吐性方案化疗的肿瘤患者，筛选应用帕诺洛司琼加地塞米松预防失败后，呕吐达到常见不良反应术语评定标准（CTCAE）3级且需追加其他止吐药物解救治疗的患者104例，于第2周期同一方案化疗期间加用福沙匹坦（150 mg静脉滴注，第1天）止吐，并进行自身对照研究，比较患者应用福沙匹坦前后呕吐反应情况。结果：第2周期加用福沙匹坦后患者1、2和3级呕吐发生率分别为70.2%、28.8%和1.0%，呕吐严重程度与第1周期相比，差异具有统计学意义（P<0.001）。亚组分析结果显示，男性和女性患者呕吐严重程度均显著轻于第1周期（P<0.001）。年龄<60岁和年龄≥60岁的患者呕吐严重程度均显著轻于第1周期（P<0.001）。有孕吐史的患者第2周期呕吐严重程度显著轻于第1周期（P<0.001）。有焦虑或抑郁病史和无焦虑或抑郁病史的患者第2周期呕吐严重程度均显著轻于第1周期（P<0.001）。福沙匹坦的常见不良反应有便秘、呃逆、丙氨酸氨基转移酶升高、食欲下降。结论：福沙匹坦与帕诺洛司琼及地塞米松联合可以显著改善中重度致吐性方案化疗诱发的呕吐。

Objective: To evaluate the efficacy of fosaprepitant for prevention of highly and moderately emetogenic chemotherapy-induced vomiting. Methods: 104 tumor patients who received highly or moderately emetogenic chemotherapy in Jiangsu cancer hospital from January 2020 to December 2020 were included. All patients suffered CTCAE grade 3 vomiting and required rescue treatment with other antiemetic drugs after failure of palonosetron plus dexamethasone prevention. During the second cycle of the same chemotherapy regimen, fosaprepitant(150 mg intravenous infusion, the first day) was added. Self-control study was conducted to compare the vomiting response of patients before and after the application of fosaprepitant. Results: The incidences of grade 1, 2, 3 vomiting episodes were 70.2%, 28.8% and 1.0% in the second cycle chemotherapy respectively. The degree of vomiting was significantly improved after using fosaprepitant(P<0.001). In subgroup analysis, the severity of vomiting in both male and female patients was significantly less than that of the first cycle(P<0.001). The severity of vomiting in patients aged < 60 years and ≥ 60 years were significantly less than that of the first cycle(P<0.001). Patients with a history of morning sickness had a significantly less vomiting in the second cycle than that of the first cycle(P<0.001). Patients with a history of anxiety or depression and no history of anxiety or depression had a significantly less vomiting severity in the second cycle than that of the first cycle(P<0.001). The common adverse reactions of fosaprepitant are constipation, hiccup, elevated alanine aminotransferase and anepithymia. Conclusion: Combination of fosaprepitant with panolosetron and dexamethasone could effectively control the vomiting in patients receiving highly or moderately emetogenic chemotherapy.

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