| Objective:In this study,we retrospectively evaluated the efficacy of different antiemetic regimens in the prevention of nausea and vomiting(CINV)caused by highly emetogenic chemotherapy in patients with invasive breast cancer,and analyzed the efficacy of NK-1 receptor antagonists,5-HT3 receptor antagonists and dexamethasone,exploring the optimal antiemetic regimen.Methods:The study subjects were invasive breast cancer patients who were hospitalized in the Department of Breast Surgery,Tongji Hospital from January 1,2017 to December 31,2018.A total of 1076 patients were enrolled.There are four antiemetic regimens in this study:three-drugs three-day regimen,three-drugs one-day regimen,two-drugs three-day regimen,and two-drugs one-day regimen.Three-drugs three-day regimen:NK-1 receptor antagonist combined with 5-HT3 receptor antagonist and dexamethasone from day 1 to day 3.Three-drugs one-day regimen: NK-1 receptor antagonist combined with 5-HT3 receptor antagonist and dexamethasone on day 1;NK-1 receptor antagonist combined with dexamethasone from day 2 to day 3.Two-drugs three-day regimen:5-HT3 receptor antagonist combined with dexamethasone from day 1 to day 3.Two-drugs one-day regimen :5-HT3 receptor antagonist combined with dexamethasone on day 1;dexamethasone from day 2 to day three.According to different antiemetic regimens,the data were recorded into the three-drugs three-day group,three-drugs one-day group,two-drugs three-day group,and two-drugs one-day group.The degree of nausea and vomiting in each group was evaluated according to the National Cancer Institute CTCAE v4.0 standard from the day of chemotherapy until the fifth day after chemotherapy,and was rated according to the corresponding criteria.The complete response rate of nausea and vomiting in the overall phase(d1-d5),acute phase(d1),and delay period(d2-d5)of each group was calculated,and then the complete remission rate of nausea and vomiting in different groups was compared by chi-square test.Differences were evaluated for the efficacy of different antiemetic regimens.Rresults:1.Three-drugs three-day group compared with two-drugs three-day group: the complete response rate of vomiting in the was 66.7% vs 52.8%,69% vs 60.1%,74.3% vs 65.4%,respectively.Statistical significance,P <0.05;nausea complete response rate in the whole course,acute phase,and delayed phase were 29.9% vs 24.1%,35.7% vs 30.2%,40.9% vs37.0%,the difference was not statistically significant,P> 0.05.2.The triple-day group was compared with the second-day group: the complete response rate of vomiting in the whole,acute,and delayed periods was 65.3% vs 40.0%,67.3% vs47.3%,73.5% vs 54.5%,and the difference was statistically significant.Significance,P<0.05;the complete response rate of nausea in the whole course,acute phase and delayed phase was 28.6% vs 23.7%,32.7% vs 27.3%,38.8% vs 34.5%,the difference was not statistically significant,P>0.05.3.Compared with the two-day group,the triple-three-day group: the complete response rate of vomiting in the whole,acute,and delayed periods was 66.7% vs 40.0%,69.0% vs 47.3%,and 74.3% vs 54.5%,respectively.The significance of learning,P <0.05;the complete response rate of nausea in the whole course,acute phase,and delayed phase were 29.9% vs23.7%,35.7% vs 27.3%,40.9% vs 34.5%,the difference was not statistically significant,P>0.05.4.Compared with the two-day group,the triple-day group had a complete remission rate of65.3% vs 52.8%,67.3% vs 60.0%,73.5% vs 65.4% in the whole course,acute phase and delayed phase,respectively.Statistical significance,P>0.05;the complete response rate of nausea in the whole course,acute phase and delayed phase was 28.6% vs 24.1%,32.7% vs30.2%,38.8% vs 37.0%,the difference was not statistically significant,P> 0.05.5.Compared with the triple-day group,the triple-three-day group had a complete remission rate of 66.7% vs 65.3% and 74.3% vs 73.5%,respectively,and the difference was not statistically significant(P>0.05).The complete response rate of nausea in the delayed period was 29.9% vs 28.6%,40.9% vs 38.8%,and the difference was not statistically significant(P>0.05).6.Compared with the two-day group,the two-day three-day group had a complete remission rate of 52.8% vs 40.0% and 65.4% vs 54.5%,respectively,and the difference was not statistically significant(P>0.05).The complete nausea response rates during the wholeand delayed periods were 24.1% vs 23.7% and 37.0% vs 34.5%,respectively,and the difference was not statistically significant(P>0.05).Conclusion:1.In patients with invasive breast cancer,when a single-day high-emetic chemotherapeutic drug containing anthracycline is used,the addition of NK-1 receptor antagonist to the5-HT3 receptor antagonist combined with dexamethasone can significantly improve the acute phase.Delayed,full vomiting complete remission rate,but can not significantly improve the acute,delayed,full nausea complete remission rate.The triple antiemetic regimen can significantly alleviate the symptoms of vomiting,but it is not effective in preventing nausea.It is speculated that the mechanism of nausea and vomiting may be different.2.In patients with invasive breast cancer who use a high-emetic chemotherapeutic drug containing anthracyclines for a single day,the use of 5-HT3 antagonists for several consecutive days in the two-way antiemetic regimen can improve the complete response rate of vomiting in the delayed phase to some extent.However,the increase in the rate of complete vomiting after the use of 5-HT3 receptor antagonists in the triple antiemetic regimen was almost unchanged.3.NK-1 receptor antagonists have obvious effects on acute and delayed vomiting,while5-HT3 receptor antagonists mainly play a role in acute vomiting,and the antiemetic effect in delayed phase is weaker than NK-1.Receptor antagonist. |
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