三联止吐治疗黑色素瘤患者因顺铂引起的恶心呕吐的疗效
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摘要
目的探讨黑色素瘤患者使用阿瑞匹坦三联止吐方案治疗顺铂化疗引起恶心呕吐的临床疗效。方法选取2014年7月至2016年7月间北京大学肿瘤医院暨北京市肿瘤防治研究所收治的采用顺铂化疗的296例黑色素瘤患者进行回顾性分析。将使用阿瑞匹坦治疗的137例患者纳入阿瑞匹坦组,未使用阿瑞匹坦治疗的136例患者纳入常规治疗组,因费用问题化疗第一周期未使用阿瑞匹坦,第二周期开始使用阿瑞匹坦治疗的23例患者纳入对照组,比较三组患者治疗后的临床疗效和不良反应。结果阿瑞匹坦组患者完全缓解率(无呕吐无解救治疗)为83. 9%(115/137),常规治疗组为22. 8%(31/136),阿瑞匹坦组高于常规治疗组。阿瑞匹坦组患者1～3级呕吐发生率均低于常规治疗组,需要胃复安解救者为15. 3%(21/137),低于常规治疗组;阿瑞匹坦组患者恶心情况也优于常规治疗组,差异均有统计学意义(均P <0. 05)。对照组患者联合使用阿瑞匹坦后,发生恶心呕吐明显下降,恶心降低2级和3级的分别为30. 4%(7/23)和8. 7%(2/23),呕吐降低2级和3级的分别为34. 8%(8/23)和17. 4%(4/23),差异均有统计学意义(均P <0. 05)。阿瑞匹坦是影响患者呕吐反应的最主要因素,阿瑞匹坦组患者无呕吐发生概率是常规治疗组的3. 71倍。常规治疗组中,性别和年龄不同患者的恶心、呕吐比较,差异均无统计学意义(均P> 0. 05)。阿瑞匹坦组患者便秘及乏力等不良反应与常规治疗组比较,差异无统计学意义(P> 0. 05)。结论联合阿瑞匹坦的止吐方案可较好改善黑色素瘤患者由顺铂化疗引起的恶心呕吐反应,且不良反应小,患者可耐受,安全性良好。
Objective To explore the efficacy of triple antiemetic regimens for cisplantin-induced nausea and vomiting in patients with melanoma. Methods From July 2014 to July 2016,296 melanoma patients receiving cisplatin chemotherapy were selected conveniently from Peking University Cancer Hospital& Beijing Institute for Cancer Research,and they were retrospectively analyzed. Patients receiving aripitant were included into the aripitant group( 137 patients),and patients who did not receive aripitant were included into the conventional treatment group( 136 patients). Patients who did not receive aripitant because of the cost during the first period of therapy and who began to use aripitant during the second period of therapy were included in the control group( 23 patients). Efficacy and adverse reactions were analyzed among the three groups. Results The complete remission rate was 83. 9%( 115/137) for the aripitant group which was significantly higher than 22. 8%( 31/136) in the conventional treatment group( P < 0. 05). The incidence rate of grade 1 to 3 vomiting was lower in the aripitan group than in the conventional treatment group( P < 0. 05). The use rate of metoclopramide was 15. 3%( 21/137) in the aripitan group which was lower than the converntional treatment group( P < 0. 05). The incidence of nausea was lower in the aripitan group than in the conventional treatment group( P < 0. 05). The incidence of nausea deceased in the aripitan group and the decrease of grade 2 and 3 nausea was 30. 4( 7/23) and 8. 7%( 2/23). The decrease of grade 2 and 3 vomiting was 34. 8%( 8/23) and 17. 4%( 4/23)( all P < 0. 05). Aripitan was the main factor influencing the nausea and vomiting. The incidence of non-vomiting was 3. 71 times in the aripitan group than in the conventional group. There was no significant difference in the incidence of vomiting among patients of different age and gender. There was no significant difference in the incidence of main adverse reactions including mild constipation and fatigue between the two groups( P > 0. 05). Conclusion The antiemetic regimen of aripitan can significantly improve the nausea and vomiting reaction in patients with melanoma on cisplatin chemotherapy with few adverse reactions,good safety and tolerance.
Objective To explore the efficacy of triple antiemetic regimens for cisplantin-induced nausea and vomiting in patients with melanoma. Methods From July 2014 to July 2016,296 melanoma patients receiving cisplatin chemotherapy were selected conveniently from Peking University Cancer Hospital& Beijing Institute for Cancer Research,and they were retrospectively analyzed. Patients receiving aripitant were included into the aripitant group( 137 patients),and patients who did not receive aripitant were included into the conventional treatment group( 136 patients). Patients who did not receive aripitant because of the cost during the first period of therapy and who began to use aripitant during the second period of therapy were included in the control group( 23 patients). Efficacy and adverse reactions were analyzed among the three groups. Results The complete remission rate was 83. 9%( 115/137) for the aripitant group which was significantly higher than 22. 8%( 31/136) in the conventional treatment group( P < 0. 05). The incidence rate of grade 1 to 3 vomiting was lower in the aripitan group than in the conventional treatment group( P < 0. 05). The use rate of metoclopramide was 15. 3%( 21/137) in the aripitan group which was lower than the converntional treatment group( P < 0. 05). The incidence of nausea was lower in the aripitan group than in the conventional treatment group( P < 0. 05). The incidence of nausea deceased in the aripitan group and the decrease of grade 2 and 3 nausea was 30. 4( 7/23) and 8. 7%( 2/23). The decrease of grade 2 and 3 vomiting was 34. 8%( 8/23) and 17. 4%( 4/23)( all P < 0. 05). Aripitan was the main factor influencing the nausea and vomiting. The incidence of non-vomiting was 3. 71 times in the aripitan group than in the conventional group. There was no significant difference in the incidence of vomiting among patients of different age and gender. There was no significant difference in the incidence of main adverse reactions including mild constipation and fatigue between the two groups( P > 0. 05). Conclusion The antiemetic regimen of aripitan can significantly improve the nausea and vomiting reaction in patients with melanoma on cisplatin chemotherapy with few adverse reactions,good safety and tolerance.
引文
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[10] Uchino J,Hirano R,Tashiro N,et al. Efficacy of aprepitant in patients with advanced or recurrent lung cancer receiving moderately emetogenic chemotherapy[J]. Asian Pac J Cancer Prev,2012,13:4187-4190.
[11]于莉,张晓晔.阿瑞匹坦在实体肿瘤化疗止吐治疗的研究进展[J].中国肿瘤临床与康复,2016,23:1148-1152.
[2]郭军.恶性黑色素瘤治疗的新进展[J].临床肿瘤学杂志,2007,12:881-884.
[3]苏婧,罗以,朱悦红,等.阿瑞匹坦联合托烷司琼、地塞米松预防顺铂化疗后呕吐的临床观察[J].湖南师范大学学报(医学版),2016,13:60-63.
[4]白玉环,朱巍.阿瑞匹坦在止吐方面的应用进展[J].医学理论与实践,2017,30:2687-2688.
[5]于世英,印季良,秦淑逵,等肿瘤治疗相关呕吐防治指南(2014版)[J].临床肿瘤学杂质,2014,19:263-273.
[6] Hu Z,Cheng Y,Zhang H,et al. Aprepitant triple therapy for the prevention of chemotherapy-induced nausea and vomiting following high-dose cisplatin in Chinese patients:arandomized,double-blind,placebo-controlled phaseⅢtrial[J]. Support Care Cancer,2014,22:979-987.
[7]毛丽丽,斯璐,王轩,等.阿瑞匹坦对黑色素瘤患者顺铂治疗引起恶心呕吐的止吐作用[J].肿瘤防治研究,2015,7:1000-8578.
[8] HU W,Fang J,Nie J,et al. Addition of aprepitant in patient improves protection against cisplatin-induced emesis when a conventional anti-emetic regimen fails[J]. Cancer Chemother Pharmacol,2014,73:1129-1136.
[9]孟文静,汪旭,贾勇圣,等.阿瑞匹坦预防高致吐性化疗所致恶心呕吐的效果和安全性评价[J].吉林大学学报(医学版),2016,42:331-335.
[10] Uchino J,Hirano R,Tashiro N,et al. Efficacy of aprepitant in patients with advanced or recurrent lung cancer receiving moderately emetogenic chemotherapy[J]. Asian Pac J Cancer Prev,2012,13:4187-4190.
[11]于莉,张晓晔.阿瑞匹坦在实体肿瘤化疗止吐治疗的研究进展[J].中国肿瘤临床与康复,2016,23:1148-1152.