| Objective: Review the effect of aprepitant plus tropisetron or azasetron and dexamethasone for prevention of nausea and vomiting in patients receiving highly emetogenic chemotherapy(HEC),moderately emetogenic chemotherapy(MEC)and low emetogenic chemotherapy from 2014 to 2016,In order to gain more experience in clinical.Methods: Review and follow-up by telephone and clinics,medical records,etc.the end of follow-up time was 23 December 2016.Application SPSS21.0 statistical software for data analysis.The rate comparison was performed using Log-rank test,with P <0.05 was considered statistically significant.Observation is divided into three stages,whole study phase 0-120 h after chemotherapy administration,acute phases 0-24 h,and delayed phases 24-120 h.In the patients the primary endpoint was complete response(CR:no vomiting and no rescue antiemetics)during the whole study phase.The second endpoints included complete protection(CP: CR plus no significant nausea).Results: 1.Clinical data and features: Patients’ s onset age mostly above 50years(88.5%),mainly between 50-70 years of age(68.7%),five patients older than 80 years;predominantly male(67.9%);Nearly half of the patients with a history of alcohol(44.3%);Karnofsky score ≥80 were 95 cases(72.5%);All patients with malignant tumor staging for stage IV,lung cancer 92 cases(70.2%),digestive tract tumor 24 cases(18.3%),lymphoma 7 cases(5.3%),other cancer 8 cases(6.1%).All patients were treated with chemotherapy,highly emetogenic chemotherapy(HEC)93 cases(70.99%),using cisplatin 81 cases(61.8%),cyclophosphamide 10 cases(7.63%),kappa lamictal 2 cases,moderately emetogenic chemotherapy(MEC)30 cases(22.9%),low emetogenic chemotherapy 8 cases(6.11%).Cisplatin dosage(75-80 mg/m2)is divided into three days,;Cyclophosphamide dosage were greater than 1000 mg.Anti-nausea plan: the first day,aprepitant 125 mg,1 hour prior to the start of chemotherapy;infusion tropisetron 5mg or azasetron10 mg and dexamethasone 10 mg 30 minutes before chemotherapy;the second and third day early morning,aprepitant 80 mg,infusion tropisetron or azasetron and dexamethasone before chemotherapy.After chemotherapy 0-120 hours,if the patient appears III degree of gastrointestinal reaction,give anti-nausea drugs timely.2.In the whole study phase,87.8% of patients achieved CR;in acute phases and delayed phases were88.5%,86.3%.And CP were50.4%、83.2%、49.6%.3.In the delayed phases 24-120 h,more than 80% of the patients needed no treatment to CINV.And half of the patients can achieve complete protection.Forteen patients appear IV degree of gastrointestinal reaction,giving anti-nausea drugs ineffectively,then declined further treatment because of new stealth factors.4.Eighty-one patients received cisplatin chemotherapy.In the whole study phase,90.1% of patients achieved CR;in acute phases and delayed phases were90.1%,87.7%.And CP were49.4%,85.2%,48.1%.5.One patient who has a lung cancer achieved CP during the first cycle of chemotherapy.Because of economic reasons,he give up using aprepitant during the second cycle of chemotherapy,then he appeared III degree of gastrointestinal reaction on the day of chemotherapy,using aprepitant still can achieve complete protection6.I all the patients,we haven’t found not tolerate side effects.More than 90% of the patients with no discomfort,just one case appeared a mild diarrhea,considering has something to do with chemotherapy drugs.7.Anti-nausea effect has nothing to do with chemotherapy drugs,c2=2.07,P=0.72;Anti-nausea effec has nothing to do with the malignant tumor of patients,c2=4.70,P=0.32;anti-nausea effect has nothing to do with gender c2=1.15,P=0.56;anti-nausea effect has nothing to do with the patient’s physical condition c2=1.6;P=0.439;anti-nausea effect has nothing to do with alcohol c2=0.544;P=0.762.8.Anti-nausea effect has significant relationship with age distribution.Along with the age growth,anti-nausea effect gradually reduced c2=17.7;P=0.001.Conclusion: 1.Aprepitant plus tropisetron and dexamethasone prevent effectively CNIV of patients receiving HEC,MEC and low emetogenic chemotherapy.And consistent with the literature,it has becomethe recommended scheme of the guideline.2.The methods improve the quality of life and the compliance of chemotherapy,with no increased toxicity reaction.3.Anti-nausea effect is inversely proportional to the patient’s age.Older patients and patients with a history of alcohol during chemotherapy are recommended using aprepitant anti-nausea,in order to reduce the occurrence of vicious vomiting4.Patients who interrupt to use aprepitant can still continue to use it after 1-2 chemotherapy cycles.5.For patients who use cisplatin,aprepitant can effectively prevent the happening of the delayed nausea and vomiting.6.Whether the digestive tract tumor or other tumors,the anti-nausea effect of aprepitant is similar.7.the anti-nausea effect of aprepitant has nothing to do with patient’s gender and physical condition. |
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