首页> 外文期刊>Journal of pain and symptom management. >Antiemetic prophylaxis with ondansetron and methylprednisolone vs metoclopramide and methylprednisolone in mild and moderately emetogenic chemotherapy.
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Antiemetic prophylaxis with ondansetron and methylprednisolone vs metoclopramide and methylprednisolone in mild and moderately emetogenic chemotherapy.

机译:恩丹西酮和甲基强的松龙与甲氧氯普胺和甲基强的松龙在轻度和中度呕吐化疗中的止吐预防作用。

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The purpose of the present study was to examine whether its is possible to successfully replace ondansetron (OND) with metoclopramide (MCP) in patients exposed to moderately emetogenic chemotherapy who did not experience severe nausea and vomiting while undergoing OND treatment during their first chemotherapy cycle. After switching to MCP, patients continued with this drug for three cycles, provided that they had adequate control of nausea and vomiting. Otherwise, they were switched back to OND. There were 76 patients, 60 women and 16 men, whose median age was 56 (mean 58) years. Karnofsky performance status score was 100 in 18 patients, 90 in 23, and 80 in 11 patients. No patient had previous chemotherapy. Thirty-four patients had breast cancer and received fluorouracil 500 mg/m2, epirubicin 100 500 mg/m2, and cyclophosphamide 500 mg/m2. Twelve patients had small cell lung cancer and received carboplatin 400 mg/m2 + etoposide 120 mg/m2 x 3 days. Twenty patients with ovarian cancer received carboplatin 350 mg/m2 and cyclophosphamide 500 mg/m2. Ten patients had cancer of unknown primary and received carboplatin 400 mg/m2, epirubicin 60 mg/m2, and etoposide 120 mg/m2 x 3 days. The OND schedule consisted of methylprednisolone 40 mg intravenous bolus followed by OND 8 mg in a 15-min infusion before chemotherapy, followed by OND 4 mg orally x 3 on the same and the next 2 days. Patients who did not experience nausea and vomiting with OND continued with an MCP schedule consisting of methylprednisolone 40 mg bolus followed by MCP 2 mg/kg in a 15-min infusion before chemotherapy, followed by MCP (20 mg x 4 on the day of therapy and the next 2 days after). Patients who failed with MCP or OND continued with OND. Considering our results as a whole, the intensity of nausea does not appear to influence the results of Gralla's scale. The results of Gralla's scale do not appear to be affected by the analysis of the antiemetic results and nausea on the next 2 days following chemotherapy administration. Overall, patients received 145 cycles with OND and 159 cycles with MCP. Of the 76 patients receiving OND-based antiemetic regimen during the first cycle, 13 (21%) experienced severe vomiting (Grade 2, 3) and the remaining 63 (79%) had mild or no vomiting (Grade 0, 1). Patients with Grade 0, 1 vomiting (63, 83%) continued with MCP in the second cycle. The final number of patients who failed on MCP, after 4 cycles of chemotherapy increased to 33 (43%); 43 (57%) were able to complete chemotherapy with MCP. Headache occurred in 15 (10%) cycles with OND and 8 (5%) with MCP. Flushing was noted in 12 (8%), and constipation occurred in 43 (30%) of OND cycles, and extrapyramidal manifestations occurred in 3 (5%) of patients receiving MCP. Diarrhea was noted in 3 (2%) of cycles with OND and in 28 (18%) with MCP. The cost ratio between MCP and OND was 1:14. If we administered OND only in patients who needed it, the overall cost decreased to 44%. Following the strategy applied in the present study, the cost decreased to 47%.
机译:本研究的目的是研究在接受中度致呕性化疗但在第一个化疗周期中接受OND治疗时未经历严重恶心和呕吐的患者,是否有可能成功地用甲氧氯普胺(MCP)替代恩丹西酮(OND)。改用MCP后,如果患者能充分控制恶心和呕吐,则继续使用该药三个周期。否则,它们将切换回OND。有76位患者,其中60位女性和16位男性,中位年龄为56岁(平均58岁)。 Karnofsky绩效状态评分18例为100,23例为90,11例为80。没有患者曾经接受过化疗。 34例乳腺癌患者接受了500 mg / m2的氟尿嘧啶,100500 mg / m2的表柔比星和500 mg / m2的环磷酰胺。 12名患有小细胞肺癌的患者,接受卡铂400 mg / m2 +依托泊苷120 mg / m2 x 3天。 20名卵巢癌患者接受卡铂350 mg / m2和环磷酰胺500 mg / m2。 10名患者患有原发性未知的癌症,并接受卡铂400 mg / m2,表柔比星60 mg / m2和依托泊苷120 mg / m2 x 3天。 OND时间表包括40 mg甲基强的松龙静脉推注,然后在化疗前15分钟内输注OND 8 mg,然后在同一天和接下来的2天口服4 mg x 3口服OND。未经历恶心和OND呕吐的患者继续进行MCP方案,包括40 mg甲基泼尼松龙推注,然后在化疗前15分钟内输注MCP 2 mg / kg,然后进行MCP(治疗当天20 mg x 4以及之后的2天)。 MCP或OND失败的患者继续OND。从整体上考虑我们的结果,恶心的强度似乎不会影响格拉拉量表的结果。服用化疗后的第二天,对止吐结果和恶心的分析似乎不会影响格拉拉氏量表的结果。总体而言,患者接受145个OND周期和159个MCP周期。在第一周期中接受基于OND止吐方案的76例患者中,有13例(21%)经历了严重的呕吐(2、3级),其余63例(79%)出现了轻度或无呕吐(0、1级)。呕吐为0级,1级的患者(63%,83%)在第二个周期继续接受MCP。经过4个周期的化疗后,MCP失败的最终患者人数增加到33(43%); 43名(57%)能够完成MCP化疗。使用OND发生头痛的周期为15(10%),使用MCP发生头痛的周期为8(5%)。在12例(8%)中出现潮红,在43例(30%)OND周期发生便秘,在3例(5%)接受MCP的患者中出现锥体外系表现。在使用OND的3个周期(2%)和使用MCP的28个周期(18%)中发现腹泻。 MCP和OND之间的成本比为1:14。如果我们仅在需要OND的患者中使用OND,则总成本将降至44%。遵循本研究中应用的策略,成本降低到47%。

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