阿瑞匹坦对乳腺癌AC方案化疗后中重度呕吐患者的二级预防

Aprepitant as secondary prevention in moderate-severe vomiting caused by AC chemotherapy for breast cancer

目的观察分析联合应用阿瑞匹坦、盐酸托烷司琼、地塞米松二级预防乳腺癌术后蒽环类药物联合环磷酰胺(AC方案)化疗所致恶心呕吐的疗效及不良反应。方法选取2015年1月至2016年5月在山东省德州市市立医院肿瘤科住院治疗的乳腺癌术后AC方案首次化疗相关性恶心呕吐(chemotherapy-induced nausea and vomiting,CINV)为中重度的患者72例,随机分为观察组35例,对照组37例。继续化疗过程中,观察组使用阿瑞匹坦+盐酸托烷司琼+地塞米松三联止吐药物预防CINV,对照组使用盐酸托烷司琼+地塞米松预防CINV。观察两组患者化疗后急性期(0~24h)及延迟期(24~120h)预防恶心呕吐的效果及不良反应发生情况。结果两组患者急性期呕吐的完全控制率比较,差异无统计学意义(P>0.05),观察组急性期呕吐的有效控制率较对照组明显升高,差异有统计学意义(P<0.05);观察组延迟期呕吐的完全控制率及有效控制率均高于对照组,差异均有统计学意义(P<0.05)。两组患者不良反应主要为便秘、疲乏、面色潮红、焦虑及头晕等,均症状轻微。结论对乳腺癌AC方案化疗后中重度呕吐患者,化疗过程中给予阿瑞匹坦三联止吐治疗效果好,经济效益较高,且不良反应轻微,患者可耐受。

Objective To evaluate the efficacy and side effects of combination therapy with aprepitant, tropisetron and dexamethasone in the prevention of nausea and vomiting induced by AC chemotherapy in patients after breast cancer surgery. Methods 72 breast cancer patients were selected for this study. Those patients were admitted to the Oncology Department in Dezhou Municipal Hospital from January 2015 to May 2016. The patients were randomly divided into observation group （35 cases） and control group （37 cases）. All patients underwent breast cancer surgery and followed by AC program for the first time chemotherapy. Chemotherapy induced nausea and vomiting （CINV） were rated moderate to severe during the course of chemotherapy. The patients in the observation group were treated with aprepitant, tropisetron hydrochloride and dexamethasone to prevent CINV. The control group was treated with tropisetron hydrochloride and dexamethasone. The efficacy and adverse re actions in acute phase （0- 24 h） and delay phase （24-120 h） were recorded. Results There was no significant difference in the complete control rate （CR） between the two groups during acute phase （P〉0. 05）. The observation group had significantly higher effective control rate （CR-PR） in acute phase compared to the control group （P〈0.05）. Both CR and CR＋PR were statistically higher in observation group during delay phase （P〈0.05）. The main adverse reactions in two groups were consti pation, fatigue, facial flushing, anxiety and dizziness. Those side effects are considered as mild and tolerable. Conclusion Tri- ple antlemetlc therapy including aprepitant has good efficacy and reasonable cost to effect ratio for patients received AC chemo therapy after breast cancer surgery with moderate-severe vomiting. This treatment is easy to accept for those patients.