Background: The current antiemetic prophylaxis for patients treated with highly emetogenic chemotherapy (HEC) included the olanzapine-based triplet and neurokinin-1 receptor antagonists (NK-1RAs)-based triplet. However, which one shows better antiemetic effect remained unclear.
Materials and methods: We systematically reviewed 43 trials, involving 16,609 patients with HEC, which compared the following antiemetics at therapeutic dose range for the treatment of chemotherapy-induced nausea and vomiting: olanzapine, aprepitant, casopitant, fosaprepitant, netupitant, and rolapitant. The main outcomes were the proportion of patients who achieved no nausea, complete response (CR), and drug-related adverse events. A Bayesian network meta-analysis was performed.
Results: Olanzapine-based triple regimens showed significantly better no-nausea rate in overall phase and delayed phase than aprepitant-based triplet (odds ratios 3.18, 3.00, respectively), casopitant-based triplet (3.78, 4.12, respectively), fosaprepitant-based triplet (3.08, 4.10, respectively), rolapitant-based triplet (3.45, 3.20, respectively), and conventional duplex regimens (4.66, 4.38, respectively). CRs of olanzapine-based triplet were roughly equal to different NK-1RAs-based triplet but better than the conventional duplet. Moreover, no significant drug-related adverse events were observed in olanzapine-based triple regimens when compared with NK-1RAs-based triple regimens and duplex regimens. Additionally, the costs of olanzapine-based regimens were obviously much lower than the NK-1RA-based regimens.
Conclusion: Olanzapine-based triplet stood out in terms of nausea control and drug price but represented no significant difference of CRs in comparison with NK-1RAs-based triplet. Olanzapine-based triple regimens should be an optional antiemetic choice for patients with HEC, especially those suffering from delayed phase nausea.
Implications for practice: According to the results of this study, olanzapine-based triple antiemetic regimens were superior in both overall and delayed-phase nausea control when compared with various neurokinin-1 receptor antagonists-based triple regimens in patients with highly emetogenic chemotherapy (HEC). Olanzapine-based triplet was outstanding in terms of nausea control and drug price. For cancer patients with HEC, especially those suffering from delayed-phase nausea, olanzapine-based triple regimens should be an optional antiemetic choice.
背景。目前针对高致吐性化疗 (HEC) 患者的止吐预防治疗包括含奥氮平的三联方案以及含神经激肽‐1 受体拮抗剂 (NK‐1RAs) 的三联方案。但是, 尚不清楚哪一种方案的止吐效果更佳。
材料和方法。我们系统回顾了 43 项试验, 涉及 16 609 名 HEC 患者, 这些试验比较了以下止吐剂在治疗剂量范围内对化疗所致恶心呕吐的治疗：奥氮平、阿瑞匹坦、卡索匹坦、福沙匹坦、奈妥匹坦和罗拉匹坦。主要结果是未出现恶心、完全缓解 (CR) 和发生药物相关不良事件的患者比例。我们进行了一项 Bayesian 网络荟萃分析。
结果。在全程和延迟期, 与含阿瑞匹坦的三联方案（比值比分别为 3.18、3.00）、含卡索匹坦的三联方案（分别为 3.78、4.12）、含福沙匹坦的三联方案（分别为 3.08、4.10）、含罗拉匹坦的三联方案（分别为 3.45、3.20）以及常规二联方案（分别为 4.66、4.38）相比, 含奥氮平的三联方案显示出的无恶心率显著更佳。含奥氮平的三联方案的 CR 大体等于不同的含 NK‐1RA 的三联方案, 但优于常规二联方案。而且, 与含 NK‐1RA 的三联方案以及二联方案相比, 未观察到含奥氮平的三联方案出现显著药物相关不良事件。此外, 含奥氮平的方案的费用明显低于含 NK‐1RA 的方案。
结论。在控制恶心和药物价格方面, 含奥氮平的三联方案表现突出, 但 CR 与含 NK‐1RA 的三联方案相比无显著差异。含奥氮平的三联方案应成为 HEC 患者（特别是出现延迟期恶心的患者）的一项止吐选择。
对临床实践的启示
根据本研究的结果, 在接受高致吐性化疗 (HEC) 的患者中, 含奥氮平的三联止吐方案在全程和延迟期恶心控制方面的表现优于多种含神经激肽‐1 受体拮抗剂的三联方案。在控制恶心和药物价格方面, 含奥氮平的三联方案表现突出。对于接受 HEC 的癌症患者（特别是出现延迟期恶心的患者）, 含奥氮平的三联方案应成为一项止吐选择。
Keywords: Chemotherapy‐induced nausea and vomiting; Highly emetogenic chemotherapy; Nausea; Network meta‐analysis; Neurokinin‐1 receptor antagonists; Olanzapine.
© AlphaMed Press 2018.