Background： Few studies have attempted to evaluate the use of antiemetic therapy for chemotherapyinduced nausea and vomiting （CINV） at a national level in China or to assess how treatment regimens adhere to current...Background： Few studies have attempted to evaluate the use of antiemetic therapy for chemotherapyinduced nausea and vomiting （CINV） at a national level in China or to assess how treatment regimens adhere to current guidelines. Methods： We searched the China Health Insurance Research Association （CHIRA） Database to identify patients with cancer who were 〉 18 years old and received either moderately or highly emetogenie chemotherapy （MEC and HEC, respectively） between 2008 and 2012. Patients＇ characteristics as well as usage of specific antiemetic regimens were analyzed using descriptive statistics. Results： Of the 14,548 patients included in the study, 6,477 received HEC while 8,071 were treated with MEC. Approximately 89.9% used antiemetics prophylactically to prevent acute CINV and 71.5% for delayed CINV while 9.0% were prescribed antiemetics as rescue therapy. A significantly lower proportion of patients treated with HEC received prophylactic antiemetic therapy for delayed CINV as compared to those treated with MEC （59.4% vs. 81.3 %; P〈0.001）. The HEC group had a slightly lower proportion of patients using a mixed regimen containing a 5-HT3 antagonist to prevent both acute and delayed CINV than the MEC group （P〈0.012）; however, a higher proportion received a mixed regimen containing eorticosteroids （P≤0.007）. Although more than half of the patients in the HEC group took three antiemeties to prevent acute and delayed CINV, these rates were significantly lower than those of the MEC group （both P〈0.001）. Finally, analysis of the regimens used revealed that there is over-utilization of drugs within the same class of antiemetic. Conclusions： These findings indicate that more attention is needed for treatment of delayed CINV, in terms of both overall use and the components of a typical treatment regimen.展开更多
BACKGROUND A new,oral fixed dose combination of highly selective neurokinin-1 receptor antagonist,netupitant with 5HT3 receptor antagonist,netupitant and palonosetron(NEPA)was approved in India for prevention of chemo...BACKGROUND A new,oral fixed dose combination of highly selective neurokinin-1 receptor antagonist,netupitant with 5HT3 receptor antagonist,netupitant and palonosetron(NEPA)was approved in India for prevention of chemotherapy induced nausea and vomiting(CINV).AIM To assess effectiveness of NEPA in real-world scenario.METHODS We retrospectively assessed the medical records and patient dairies of adult patients who received highly emetogenic or moderately emetogenic chemotherapy(HEC/MEC)and treated with NEPA(Netupitant 300 mg+Palanosetron 0.50 mg)for prevention of CINV.Complete response(CR)was defined as no emesis or no requirement of rescue medication in overall phase(0 to 5 d),acute phase(0-24 h)and delayed phase(2 to 5 d).RESULTS In 403 patients included in the analysis,mean age was 56.24±11.11 years and 55.09%were females.Breast cancer(25.06%)was most common malignancy encountered.HEC and MEC were administered in 54.6%and 45.4%patients respectively.CR in overall phase was 93.79%whereas it was 98.01%in acute CINV and 93.79%in delayed CINV.Overall CR in HEC and MEC groups was 93.63%and 93.98%respectively.CR was more than 90%in different chemotherapy cycles except in group of patients of cycle 4 where CR was 88.88%.CONCLUSION NEPA is a novel combination that is effective in preventing CINV in up to 93%cases treated with highly emetogenic or moderately emetogenic chemotherapy.This study brings the first real-life evidence of its effectiveness in India population.展开更多
Chemotherapy-induced nausea and vomiting (CINV) are distressing side effects of chemotherapy. Neurokinin-1 receptor antagonists (NK1-RAs) have been incorporated in the contemporary management of CINV. However, clinica...Chemotherapy-induced nausea and vomiting (CINV) are distressing side effects of chemotherapy. Neurokinin-1 receptor antagonists (NK1-RAs) have been incorporated in the contemporary management of CINV. However, clinical studies on NK1-RAs have shown mixed results in reducing CINV risk. Most studies focused on the use of aprepitant (APR) and casopitant (CAS) in breast cancer patients receiving AC-type (doxorubicin and cyclophosphamide) chemotherapy. In this study, we compared the study design and clinical efficacies of these NK1-RAs in reducing CINV risk. Among the selected eight studies, 4 APR Randomized Controlled Trials (RCTs), 2 APR Observational Studies (OSs) and 2 CAS RCTs were identified. Patient-related characteristics such as the proportion of females (60.0% - 100.0%), age (46.5 - 59.5 years), histories of motion (5.6% - 47.0% in NK1-RA arms) and morning sicknesses (14.2% - 45.0% in NK1-RA arms) and types of antiemetic regimens;as well as chemotherapy-related characteristics such as the proportion of patients on AC chemotherapy (15.0% - 100.0%) varied greatly. In terms of efficacies, both APR and CAS improved overall CR and vomiting in majority of the studies. None of the studies, however, demonstrated that NK1-RA could provide adequate nausea control. To conclude, NK1-RAs are effective in improving vomiting and overall CR, but not useful in controlling nausea or attaining CC, the ideal CINV endpoint. A shift in paradigm is needed for future CINV research. As healthcare providers continue to strive for optimum CINV control in their patients, we hope this review can help them make better informed clinical decisions.展开更多
目的比较3种工具在肿瘤静脉化疗患者急性化疗相关恶心呕吐(chemotherapy-induced nausea and vomiting,CINV)风险评估中的预测价值。方法采用便利抽样法,选取2022年1月至2022年12月在浙江省肿瘤医院肝胆胰肿瘤内科住院化疗的626例肿瘤...目的比较3种工具在肿瘤静脉化疗患者急性化疗相关恶心呕吐(chemotherapy-induced nausea and vomiting,CINV)风险评估中的预测价值。方法采用便利抽样法,选取2022年1月至2022年12月在浙江省肿瘤医院肝胆胰肿瘤内科住院化疗的626例肿瘤患者为研究对象。应用Geoge团队的CINV风险预测工具、Dranitsaris评分系统、CINV列线图模型分别预测患者急性CINV发生,绘制受试者操作特征曲线,计算曲线下面积、敏感度、特异性和约登指数以比较其预测效能。结果最终纳入研究的患者有622例,有效率为99.36%。发生CINV的患者有318例,占比51.13%:其中2级及以上急性期CINV者18.17%(113/622)。使用3种工具对急性期CINV风险评估:Geoge团队的CINV风险预测工具、Dranitsaris评分系统、CINV列线图模型AUC分别为0.591、0.616、0.558,Dranitsaris评分系统敏感度最高、George团队的CINV风险预测工具特异性最高。结论肿瘤患者化疗后CINV发生率处于较高水平,Geoge团队的CINV风险预测工具、Dranitsaris评分系统、CINV列线图模型预测对国内肿瘤患者急性期CINV预测准确度略低,需构建本土化的、适用于多病种的标准化CINV风险评估模型。展开更多
目的观察岭南火针疗法预防性治疗化疗相关性恶心呕吐(chemotherapy-related nausea and vomiting,CINV)的临床疗效。方法将60例既往出现过CINV的恶性肿瘤患者采用随机数字表法结合信封法分为对照组和治疗组各30例。对照组在化疗前30 mi...目的观察岭南火针疗法预防性治疗化疗相关性恶心呕吐(chemotherapy-related nausea and vomiting,CINV)的临床疗效。方法将60例既往出现过CINV的恶性肿瘤患者采用随机数字表法结合信封法分为对照组和治疗组各30例。对照组在化疗前30 min静脉推注盐酸托烷司琼注射液5 mg;治疗组在对照组的基础上于化疗前1天、输注化疗药当天前30 min各行岭南火针疗法一次,此为一个疗程。评估两组患者化疗前1天至化疗后第5天出现恶心呕吐的频率和程度、呕吐功能性生活指数(functional living index emesis,FLIE)评分值(恶心维度)以及化疗前1天和化疗后第5天的卡氏功能状态(karnofsky performance status,KPS)评分。结果治疗组从化疗后第1天到第5天出现的恶心、呕吐程度的缓解作用均优于对照组(P<0.05),治疗组在维持患者的体能状态上优于对照组(P<0.05)。结论岭南火针疗法联合盐酸托烷司琼注射液预治疗CINV疗效更优,特别是对呕吐的缓解,在维持体能状态方面疗效优于单纯使用西药治疗。展开更多
目的观察艾灸联合健胃止呕方穴位贴敷辅助治疗胃肠道恶性肿瘤患者化疗相关性恶心呕吐(CINV)的效果。方法采用随机数字表法将2021年9月至2024年6月接受化疗的92例胃肠道恶性肿瘤患者分为观察组46例(后脱落1例)和对照组46例。对照组化疗...目的观察艾灸联合健胃止呕方穴位贴敷辅助治疗胃肠道恶性肿瘤患者化疗相关性恶心呕吐(CINV)的效果。方法采用随机数字表法将2021年9月至2024年6月接受化疗的92例胃肠道恶性肿瘤患者分为观察组46例(后脱落1例)和对照组46例。对照组化疗前予阿扎司琼、倍他米松、甲氧氯普胺治疗,观察组在此基础上提前1 d加用艾灸及健胃止呕方穴位贴敷治疗。比较2组患者化疗前及化疗后24、48、72 h Karnofsky评分、中医症候积分、恶心呕吐指数评估量表(R-INVR)评分、简单厌食量表评分以及化疗不良反应发生情况。结果化疗24、48 h后,2组Karanofsky评分均较治疗前下降,对照组下降更明显(P<0.01);化疗72 h后对照组Karanofsky评分较化疗前下降,观察组无明显变化,且观察组高于对照组(P<0.01)。化疗24、48、72 h后2组中医症候积分总体均较化疗前升高,但观察组相对更低(P<0.01)。观察组化疗后24、48及72 h R-INVR评分低于对照组,简单厌食量表评分均高于对照组(P<0.01)。2组患者化疗后骨髓抑制、肝肾功能损伤发生率比较差异无统计学意义(P>0.05)。结论艾灸联合健胃止呕方穴位贴敷辅助治疗可有效缓解胃肠道恶性肿瘤患者CINV症状。展开更多
基金supported by MSD Holding Co.,Ltd.The funding was only for the payment of using CHIRA database
文摘Background： Few studies have attempted to evaluate the use of antiemetic therapy for chemotherapyinduced nausea and vomiting （CINV） at a national level in China or to assess how treatment regimens adhere to current guidelines. Methods： We searched the China Health Insurance Research Association （CHIRA） Database to identify patients with cancer who were 〉 18 years old and received either moderately or highly emetogenie chemotherapy （MEC and HEC, respectively） between 2008 and 2012. Patients＇ characteristics as well as usage of specific antiemetic regimens were analyzed using descriptive statistics. Results： Of the 14,548 patients included in the study, 6,477 received HEC while 8,071 were treated with MEC. Approximately 89.9% used antiemetics prophylactically to prevent acute CINV and 71.5% for delayed CINV while 9.0% were prescribed antiemetics as rescue therapy. A significantly lower proportion of patients treated with HEC received prophylactic antiemetic therapy for delayed CINV as compared to those treated with MEC （59.4% vs. 81.3 %; P〈0.001）. The HEC group had a slightly lower proportion of patients using a mixed regimen containing a 5-HT3 antagonist to prevent both acute and delayed CINV than the MEC group （P〈0.012）; however, a higher proportion received a mixed regimen containing eorticosteroids （P≤0.007）. Although more than half of the patients in the HEC group took three antiemeties to prevent acute and delayed CINV, these rates were significantly lower than those of the MEC group （both P〈0.001）. Finally, analysis of the regimens used revealed that there is over-utilization of drugs within the same class of antiemetic. Conclusions： These findings indicate that more attention is needed for treatment of delayed CINV, in terms of both overall use and the components of a typical treatment regimen.
文摘BACKGROUND A new,oral fixed dose combination of highly selective neurokinin-1 receptor antagonist,netupitant with 5HT3 receptor antagonist,netupitant and palonosetron(NEPA)was approved in India for prevention of chemotherapy induced nausea and vomiting(CINV).AIM To assess effectiveness of NEPA in real-world scenario.METHODS We retrospectively assessed the medical records and patient dairies of adult patients who received highly emetogenic or moderately emetogenic chemotherapy(HEC/MEC)and treated with NEPA(Netupitant 300 mg+Palanosetron 0.50 mg)for prevention of CINV.Complete response(CR)was defined as no emesis or no requirement of rescue medication in overall phase(0 to 5 d),acute phase(0-24 h)and delayed phase(2 to 5 d).RESULTS In 403 patients included in the analysis,mean age was 56.24±11.11 years and 55.09%were females.Breast cancer(25.06%)was most common malignancy encountered.HEC and MEC were administered in 54.6%and 45.4%patients respectively.CR in overall phase was 93.79%whereas it was 98.01%in acute CINV and 93.79%in delayed CINV.Overall CR in HEC and MEC groups was 93.63%and 93.98%respectively.CR was more than 90%in different chemotherapy cycles except in group of patients of cycle 4 where CR was 88.88%.CONCLUSION NEPA is a novel combination that is effective in preventing CINV in up to 93%cases treated with highly emetogenic or moderately emetogenic chemotherapy.This study brings the first real-life evidence of its effectiveness in India population.
文摘Chemotherapy-induced nausea and vomiting (CINV) are distressing side effects of chemotherapy. Neurokinin-1 receptor antagonists (NK1-RAs) have been incorporated in the contemporary management of CINV. However, clinical studies on NK1-RAs have shown mixed results in reducing CINV risk. Most studies focused on the use of aprepitant (APR) and casopitant (CAS) in breast cancer patients receiving AC-type (doxorubicin and cyclophosphamide) chemotherapy. In this study, we compared the study design and clinical efficacies of these NK1-RAs in reducing CINV risk. Among the selected eight studies, 4 APR Randomized Controlled Trials (RCTs), 2 APR Observational Studies (OSs) and 2 CAS RCTs were identified. Patient-related characteristics such as the proportion of females (60.0% - 100.0%), age (46.5 - 59.5 years), histories of motion (5.6% - 47.0% in NK1-RA arms) and morning sicknesses (14.2% - 45.0% in NK1-RA arms) and types of antiemetic regimens;as well as chemotherapy-related characteristics such as the proportion of patients on AC chemotherapy (15.0% - 100.0%) varied greatly. In terms of efficacies, both APR and CAS improved overall CR and vomiting in majority of the studies. None of the studies, however, demonstrated that NK1-RA could provide adequate nausea control. To conclude, NK1-RAs are effective in improving vomiting and overall CR, but not useful in controlling nausea or attaining CC, the ideal CINV endpoint. A shift in paradigm is needed for future CINV research. As healthcare providers continue to strive for optimum CINV control in their patients, we hope this review can help them make better informed clinical decisions.
文摘目的比较3种工具在肿瘤静脉化疗患者急性化疗相关恶心呕吐(chemotherapy-induced nausea and vomiting,CINV)风险评估中的预测价值。方法采用便利抽样法,选取2022年1月至2022年12月在浙江省肿瘤医院肝胆胰肿瘤内科住院化疗的626例肿瘤患者为研究对象。应用Geoge团队的CINV风险预测工具、Dranitsaris评分系统、CINV列线图模型分别预测患者急性CINV发生,绘制受试者操作特征曲线,计算曲线下面积、敏感度、特异性和约登指数以比较其预测效能。结果最终纳入研究的患者有622例,有效率为99.36%。发生CINV的患者有318例,占比51.13%:其中2级及以上急性期CINV者18.17%(113/622)。使用3种工具对急性期CINV风险评估:Geoge团队的CINV风险预测工具、Dranitsaris评分系统、CINV列线图模型AUC分别为0.591、0.616、0.558,Dranitsaris评分系统敏感度最高、George团队的CINV风险预测工具特异性最高。结论肿瘤患者化疗后CINV发生率处于较高水平,Geoge团队的CINV风险预测工具、Dranitsaris评分系统、CINV列线图模型预测对国内肿瘤患者急性期CINV预测准确度略低,需构建本土化的、适用于多病种的标准化CINV风险评估模型。
文摘目的观察岭南火针疗法预防性治疗化疗相关性恶心呕吐(chemotherapy-related nausea and vomiting,CINV)的临床疗效。方法将60例既往出现过CINV的恶性肿瘤患者采用随机数字表法结合信封法分为对照组和治疗组各30例。对照组在化疗前30 min静脉推注盐酸托烷司琼注射液5 mg;治疗组在对照组的基础上于化疗前1天、输注化疗药当天前30 min各行岭南火针疗法一次,此为一个疗程。评估两组患者化疗前1天至化疗后第5天出现恶心呕吐的频率和程度、呕吐功能性生活指数(functional living index emesis,FLIE)评分值(恶心维度)以及化疗前1天和化疗后第5天的卡氏功能状态(karnofsky performance status,KPS)评分。结果治疗组从化疗后第1天到第5天出现的恶心、呕吐程度的缓解作用均优于对照组(P<0.05),治疗组在维持患者的体能状态上优于对照组(P<0.05)。结论岭南火针疗法联合盐酸托烷司琼注射液预治疗CINV疗效更优,特别是对呕吐的缓解,在维持体能状态方面疗效优于单纯使用西药治疗。
文摘目的观察艾灸联合健胃止呕方穴位贴敷辅助治疗胃肠道恶性肿瘤患者化疗相关性恶心呕吐(CINV)的效果。方法采用随机数字表法将2021年9月至2024年6月接受化疗的92例胃肠道恶性肿瘤患者分为观察组46例(后脱落1例)和对照组46例。对照组化疗前予阿扎司琼、倍他米松、甲氧氯普胺治疗,观察组在此基础上提前1 d加用艾灸及健胃止呕方穴位贴敷治疗。比较2组患者化疗前及化疗后24、48、72 h Karnofsky评分、中医症候积分、恶心呕吐指数评估量表(R-INVR)评分、简单厌食量表评分以及化疗不良反应发生情况。结果化疗24、48 h后,2组Karanofsky评分均较治疗前下降,对照组下降更明显(P<0.01);化疗72 h后对照组Karanofsky评分较化疗前下降,观察组无明显变化,且观察组高于对照组(P<0.01)。化疗24、48、72 h后2组中医症候积分总体均较化疗前升高,但观察组相对更低(P<0.01)。观察组化疗后24、48及72 h R-INVR评分低于对照组,简单厌食量表评分均高于对照组(P<0.01)。2组患者化疗后骨髓抑制、肝肾功能损伤发生率比较差异无统计学意义(P>0.05)。结论艾灸联合健胃止呕方穴位贴敷辅助治疗可有效缓解胃肠道恶性肿瘤患者CINV症状。
