指南推荐的止吐预防可改善大多数化疗患者的恶心和呕吐控制。多国癌症支持护理协会/欧洲医学肿瘤学会(MASCC/ESMO)止吐指南建议使用神经激肽-1受体拮抗剂(NK1RA)进行预防,一种5-羟色胺-3受体拮抗剂(5-HT3RA),和地塞米松用于接受高度致吐性化疗(HEC)的患者,包括蒽环类-环磷酰胺(AC)-和卡铂(考虑中度致吐化疗)为基础的化疗。这里,我们分析了NK1RA-5-HT3RA-地塞米松用于预防与HEC和卡铂相关的止吐.
数据来源是全球肿瘤监测中心(益普索医疗)。来自法国的具有地理代表性的医生,德国,意大利,西班牙,英国接受了治疗参与情况和每月接受治疗的患者数量的筛查.2018年1月至12月的患者数据是从医学图表中收集的,并根据开化疗处方的医生总数进行推断。化疗的呕吐风险根据MASCC/ESMO指南进行分类。
收集了45,324名化疗患者的数据,代表分析中包括的1,394,848种化疗治疗的总推断患病率。NK1RA的使用率为45%,42%,19%的患者接受顺铂-,AC-,以卡铂为基础的化疗,分别为18%,24%,7%的患者接受了指南推荐的NK1RA-5-HT3RA-地塞米松联合用药;12%的患者未使用止吐药.通常,医师对化疗呕吐风险的认知未遵循MASCC/ESMO指南分类.
在五个欧洲国家的临床实践中发现,对止吐指南的依从性低。所有基于HEC/卡铂的治疗中有15%接受了指南推荐的NK1RA-5-HT3RA-地塞米松预防,其中12%未接受止吐药。迫切需要新的战略来改善指导方针的遵守情况。
尽管最近在止吐治疗方面取得了进展,相当比例的患者在日常临床实践中经历与化疗相关的恶心和呕吐。止吐指南旨在预防化疗引起的恶心和呕吐(CINV),和指南一致的止吐疗法可以有效预防呕吐,在较小程度上,大多数癌症患者的恶心。这项研究报告说,在五个欧洲国家的日常临床实践中,高度致吐性化疗方案对止吐指南的依从性较低。存在增加对止吐指南建议的依从性的机会。实施促进指南依从性的策略可能会改善CINV控制。
Guideline-recommended antiemetic prophylaxis improves nausea and vomiting control in most patients undergoing chemotherapy. Multinational Association of Supportive Care in Cancer/European Society for Medical Oncology (MASCC/ESMO) antiemetic guidelines recommend prophylaxis with a neurokinin-1 receptor antagonist (NK1 RA), a 5-hydroxytryptamine-3 receptor antagonist (5-HT3 RA), and dexamethasone for patients receiving highly emetogenic chemotherapy (HEC), including anthracycline-cyclophosphamide (AC)- and carboplatin (considered moderately emetogenic chemotherapy)-based chemotherapy. Here, we analyze the use of NK1 RA-5-HT3 RA-dexamethasone for antiemetic prophylaxis associated with HEC and carboplatin.
The data source was the Global Oncology Monitor (Ipsos Healthcare). Geographically representative physicians from France, Germany, Italy, Spain, and the U.K. were screened for treatment involvement and number of patients treated per month. Patients\' data from January to December 2018 were collected from medical charts and extrapolated on the basis of the total number of physicians who prescribe chemotherapy. The emetic risk of chemotherapy was classified per MASCC/ESMO guidelines.
Data from 45,324 chemotherapy-treated patients were collected, representing a total extrapolated prevalence of 1,394,848 chemotherapy treatments included in the analysis. NK1 RAs were used in 45%, 42%, and 19% of patients receiving cisplatin-, AC-, and carboplatin-based chemotherapy, respectively; 18%, 24%, and 7% received the guideline-recommended NK1 RA-5-HT3 RA-dexamethasone combination; no antiemetics were prescribed for 12% of the treatments. Often, physicians\' perception of the emetic risk of chemotherapy did not follow MASCC/ESMO guideline classification.
Low adherence to antiemetic guidelines was revealed in clinical practice in five European countries, with 15% of all HEC-/carboplatin-based treatments receiving guideline-recommended NK1 RA-5-HT3 RA-dexamethasone prophylaxis and 12% of them receiving no antiemetics. New strategies for improving guideline adherence are urgently needed.
Despite recent advances in antiemetic therapy, a substantial proportion of patients experience nausea and vomiting associated with chemotherapy in daily clinical practice. Antiemetic guidelines aim at prevention of chemotherapy-induced nausea and vomiting (CINV), and guideline-consistent antiemetic therapy can effectively prevent vomiting and, to a lesser extent, nausea in most patients with cancer. This study reports low adherence to antiemetic guidelines in the highly emetogenic chemotherapy setting in daily clinical practice across five European countries. Opportunity exists to increase adherence to antiemetic guideline recommendations. Implementation of strategies to facilitate guideline adherence can potentially improve CINV control.