Chemotherapy-induced nausea and vomiting is less controlled at delayed phase in patients with esophageal cancer: a prospective registration study by the CINV Study Group of Japan
Chemotherapy-induced nausea and vomiting is less controlled at delayed phase in patients with esophageal cancer: a prospective registration study by the CINV Study Group of Japan
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DOI：
10.1111/dote.12482
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发表时间：
2017-02-01
影响因子：
2.6
通讯作者：
Aiba, Keisuke
中科院分区：
文献类型：
--
作者：
Baba, Yoshifumi;Baba, Hideo;Aiba, Keisuke
化疗是食管癌不可或缺的治疗手段。虽然化疗引起的恶心呕吐（CINV）是最重要的不良事件之一，但目前食管癌患者CINV的状态仍不清楚。这项多中心前瞻性观察性研究分析了192名接受中度致吐化疗（MEC）或高度致吐化疗（HEC）的食管癌患者的数据。化疗后7天内每天记录CINV的发生率和严重程度，采用视觉模拟评分法（VAS）。192例患者中，181例接受了含顺铂的HEC，11例接受了含奈达铂的MEC。大约81%的HEC和82%的MEC患者按照指南接受了止吐治疗。尽管HEC组和MEC组的CINV在早期（第1-4天）控制得相对较好，但在晚期（第5-7天）并未完全控制。女性是迟发性呕吐的主要危险因素（P=0.034）。VAS的多变量logistic回归分析显示，晕动病、年龄和使用其他止吐药是迟发性恶心的危险因素。坚持止吐指南有效地控制呕吐，但对HEC和MEC患者的迟发性CINV效果较差。识别个体风险因素，如女性，将有助于开发CINV的个性化治疗。在食管癌的临床环境中，包括奈达铂的方案可能需要作为HEC治疗。
Chemotherapy is an indispensable therapeutic approach for esophageal cancer. Although chemotherapy-induced nausea and vomiting (CINV) is one of the most crucial adverse events, the current state of CINV in patients with esophageal cancer remains unclear. This multicenter prospective observational study analyzed data for 192 patents with esophageal cancer who underwent moderately emetogenic chemotherapy (MEC) or highly emetogenic chemotherapy (HEC). The patients recorded their CINV incidence and severity daily for 7 days after receiving chemotherapy, using visual analog scales (VAS). Of the 192 patients, 181 receivedHEC including cisplatin, and 11 patients receivedMEC including nedaplatin. Approximately 81% of HEC and 82% of MEC patients received antiemetic therapy in compliance with guidelines. Although CINV was controlled relatively well in the early phase (days 1-4), it was not fully controlled in late phase (days 5-7) for both the HEC and MEC groups. Female sex was a major risk factor for delayed vomiting (P=0.034). Multivariate logistic regression analysis for VAS revealed that motion sickness, age, and use of other antiemetics were risk factors for delayed nausea. Adherence to antiemetic guidelines effectively controls vomiting but is less effective against delayed CINV in both HEC and MEC patients. Identification of individual risk factors, such as female sex, will help develop personalized treatments for CINV. In the clinical setting for esophageal cancer, regimens that include nedaplatin might need to be treated as HEC.