5-羟色胺3受体拮抗剂预防乳腺癌化学治疗致吐的临床疗效及安全性评价

Clinical Efficacy and Safety Evaluation of 5-HT_3 Receptor Antagonist in Preventing Chemotherapy-induced Spit in Patients with Breast Cancer

目的观察3种5-HT_3受体拮抗剂预防乳腺癌蒽环类联合环磷酰胺化学治疗(化疗)引起恶心呕吐的效果和不良反应,为临床合理使用止吐药提供参考。方法将接受蒽环类联合环磷酰胺化疗的乳腺癌患者129例,根据化疗前所用止吐方案分为A组(昂丹司琼组)41例,B组(格拉司琼组)55例,C组(托烷司琼组)33例。分别观察3组止吐方案在蒽环类联合环磷酰胺化疗后0～5 d内出现恶心、呕吐等消化道反应和便秘、乏力、腹胀等不良反应。结果化疗后0～24 h和2～5 d托烷司琼组恶心、呕吐有效控制率分别为81.82%,87.88%和63.64%,69.70%,均优于同时段其他两组,但差异无统计学意义(P>0.05)。3组不良反应均轻微,总不良反应发生率差异无统计学意义(P>0.05)。结论 3组方案在预防急性化疗所致恶心呕吐(CINV)等效剂量下具有相同且较好临床疗效及安全性,但在缓解迟发性CINV上效果不理想,建议按指南推荐联合用药,5-HT_3受体拮抗剂可选用长效制剂。

Objective To observe the effects and adverse reactions of three kinds of 5-HT3 receptor antagonists in preventing nausea and vomiting caused by anthracycline combined with cyclophosphamide chemotherapy, and provide reference for clinical rational use of antiemetics. Methods Totally, 129 breast cancer patients receiving anthracycline combined with cyclophosphamide chemotherapy were divided into group A(ondansetron group, n=41 cases), group B(granisetron group, n=55 cases), group C(tropisetron group, n=33 cases), according to the antiemetic regimen used before chemotherapy. Three groups of antiemetic regimens were observed to have adverse reactions such as nausea and vomiting, constipation, fatigue, and abdominal distension within 0 to 5 days after anthracycline combined with cyclophosphamide chemotherapy. Results The effective control rates of nausea and vomiting in the tropoxane group were 81.82%, 87.88%, 63.64%, and 69.70% at 0-24 h and 2-5 d after chemotherapy, respectively, which were better than the other two groups at the same time, but the difference was not statistically significant(P>0.05). The adverse reactions of the three groups were mild, and the incidence of total adverse reactions was not statistically significant(P>0.05). Conclusion The three groups of regimens have the same and better clinical efficacy and safety in the prevention of acute CINV at equivalent dose, but the effect on remission of delayed CINV is not satisfactory. It is recommended to use combination therapy according to the guidelines. 5-HT3 receptor antagonist can be used for long-acting preparation.