Efficacy and safety of dexamethasone sparing for the prevention of nausea and vomiting associated with highly emetogenic risk antineoplastic agents: a systematic review and meta-analysis of the Clinical Practice Guidelines for Antiemesis 2023 from the Japan Society of Clinical Oncology.

IF 2.4 3区 医学 Q3 ONCOLOGY
Ayako Yokomizo, Kazuhisa Nakashima, Arisa Iba, Kenji Okita, Makoto Wada, Keiko Iino, Tatsuo Akechi, Hirotoshi Iihara, Chiyo K Imamura, Ayako Okuyama, Keiko Ozawa, Yong-Il Kim, Hidenori Sasaki, Eriko Satomi, Masayuki Takeda, Ryuhei Tanaka, Takako Eguchi Nakajima, Naoki Nakamura, Junichi Nishimura, Mayumi Noda, Kazumi Hayashi, Takahiro Higashi, Narikazu Boku, Koji Matsumoto, Yoko Matsumoto, Nobuyuki Yamamoto, Kenjiro Aogi, Masakazu Abe
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引用次数: 0

Abstract

Background: Chemotherapy-induced nausea and vomiting (CINV) are common side effects, classified according to timing and severity. Conventional agents such as dexamethasone are effective but have various side effects. For moderately emetogenic chemotherapy, dexamethasone-sparing antiemetic therapies have been developed to minimize these side effects. This systematic review evaluated the efficacy and safety of dexamethasone-sparing antiemetic therapy for highly emetogenic chemotherapy (HEC).

Methods: We performed a thorough literature search for studies related to dexamethasone-sparing antiemetic therapy with neurokinin-1 antagonists (NK1RA) for HEC using the PubMed, Cochrane Library, and Ichushi-Web databases. A qualitative analysis of the combined data was performed and risk differences with confidence intervals were calculated.

Results: Two reviewers independently assessed the 425 records and 12 full-text articles were evaluated for eligibility. Two studies were included in the qualitative and meta-analyses. These studies included anthracycline-cyclophosphamide (AC) regimens and cisplatin-based regimens, with palonosetron as the serotonin receptor antagonist. In the two studies, no difference was found in the prevention of vomiting (delayed complete response). However, non-inferiority was not demonstrated in the subgroup that received cisplatin-containing regimens. Delayed complete control showed different results for nausea prevention; however, there was no significant difference in the meta-analysis. Only one report has shown non-inferiority for delayed total control. Although the strength of evidence for individual outcomes varied, there was no difference in the duration of dexamethasone administration.

Conclusions: This systematic review and meta-analysis revealed that dexamethasone-sparing antiemetic therapy with NK1RA and palonosetron can be used to prevent CINV in HEC, limited to AC combination therapy.

疏用地塞米松预防与高致吐风险抗肿瘤药物相关的恶心和呕吐的有效性和安全性:对日本临床肿瘤学会《2023 年止吐临床实践指南》的系统回顾和荟萃分析。
背景:化疗引起的恶心和呕吐(CINV)是常见的副作用,可根据时间和严重程度进行分类。地塞米松等传统药物有效,但有各种副作用。针对中度致吐的化疗,人们开发了地塞米松稀释止吐疗法,以尽量减少这些副作用。本系统性综述评估了地塞米松保留止吐疗法对高致吐性化疗(HEC)的疗效和安全性:我们使用PubMed、Cochrane Library和Ichushi-Web数据库对有关使用神经激肽-1拮抗剂(NK1RA)对高致吐性化疗进行地塞米松稀释止吐治疗的研究进行了全面的文献检索。对合并数据进行了定性分析,并计算了风险差异和置信区间:两名审稿人独立评估了 425 条记录,并对 12 篇全文进行了资格评估。两项研究被纳入定性分析和荟萃分析。这些研究包括以蒽环类-环磷酰胺(AC)为基础的治疗方案和以顺铂为基础、以帕洛诺司琼为血清素受体拮抗剂的治疗方案。这两项研究在预防呕吐(延迟完全反应)方面未发现差异。然而,在接受含顺铂治疗方案的亚组中,非劣效性未得到证实。延迟完全控制在预防恶心方面显示出不同的结果;但在荟萃分析中没有显著差异。只有一份报告显示延迟完全控制具有非劣效性。虽然个别结果的证据强度不同,但地塞米松给药时间的长短没有差异:本系统综述和荟萃分析显示,使用NK1RA和帕洛诺司琼进行地塞米松稀释止吐疗法可用于预防HEC中的CINV,但仅限于AC联合疗法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.80
自引率
3.00%
发文量
175
审稿时长
2 months
期刊介绍: The International Journal of Clinical Oncology (IJCO) welcomes original research papers on all aspects of clinical oncology that report the results of novel and timely investigations. Reports on clinical trials are encouraged. Experimental studies will also be accepted if they have obvious relevance to clinical oncology. Membership in the Japan Society of Clinical Oncology is not a prerequisite for submission to the journal. Papers are received on the understanding that: their contents have not been published in whole or in part elsewhere; that they are subject to peer review by at least two referees and the Editors, and to editorial revision of the language and contents; and that the Editors are responsible for their acceptance, rejection, and order of publication.
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