Defining the clinical benefits of adding a neurokinin-1 receptor antagonist to control chemotherapy-induced nausea and vomiting in moderately emetogenic chemotherapy: 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 International Journal of Clinical Oncology Pub Date : 2024-09-11 DOI:10.1007/s10147-024-02623-y

Toshinobu Hayashi, Shun Yamamoto, Yoshiharu Miyata, Masayuki Takeda, Masakazu Abe, Makoto Wada, Keiko Iino, Tatsuo Akechi, Chiyo K. Imamura, Ayako Okuyama, Keiko Ozawa, Yong-Il Kim, Hidenori Sasaki, Eriko Satomi, Ryuhei Tanaka, Takako Eguchi Nakajima, Naoki Nakamura, Junichi Nishimura, Mayumi Noda, Kazumi Hayashi, Takahiro Higashi, Narikazu Boku, Koji Matsumoto, Yoko Matsumoto, Kenji Okita, Nobuyuki Yamamoto, Kenjiro Aogi, Hirotoshi Iihara

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Abstract

Background

Chemotherapy-induced nausea and vomiting (CINV) commonly affects patient quality of life and the overall effectiveness of chemotherapy. This study aimed to evaluate whether adding neurokinin-1 receptor antagonists (NK1RAs) to 5-hydroxytryptamine-3 receptor antagonists (5-HT₃RAs) and corticosteroids provides clinically meaningful benefits in preventing CINV in patients receiving moderately emetogenic chemotherapy (MEC).

Methods

We conducted a systematic review of PubMed, Cochrane Library, and Ichushi-Web to identify clinical studies evaluating NK1RAs combined with 5-HT₃RAs and dexamethasone for managing CINV in MEC. The endpoints were complete response (CR), complete control (CC), total control (TC), adverse events, and costs. The data were analyzed using a random effects model.

Results

From 142 articles identified, 15 randomized controlled trials (RCTs), involving 4,405 patients, were included in the meta-analysis. Approximately 60% of the patients received carboplatin (CBDCA)-based chemotherapy. The meta-analysis showed that triplet antiemetic prophylaxis with NK1RA was significantly more effective for achieving CR than doublet prophylaxis in each phase. Regarding CC, the triplet antiemetic prophylaxis was significantly more effective than the doublet in the overall (risk difference [RD]: 0.11, 95% confidence interval [CI]: 0.06–0.17) and delayed (RD: 0.08, 95% CI: 0.02–0.13) phases. For TC, no significant differences were observed in any phase. Adding NK1RA did not cause adverse events.

Conclusions

Adding NK1RA to CBDCA-based chemotherapy has shown clinical benefits. However, the clinical benefits of NK1RA-containing regimens for overall MEC have not yet been established and require RCTs that exclusively evaluate MEC regimens other than CBDCA-based chemotherapy.

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确定在中度致吐化疗中添加神经激肽-1 受体拮抗剂以控制化疗引起的恶心和呕吐的临床益处：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）通常会影响患者的生活质量和化疗的整体效果。本研究旨在评估在5-羟色胺-3受体拮抗剂（5-HT3RAs）和皮质类固醇的基础上添加神经激肽-1受体拮抗剂（NK1RAs）是否能在预防中度致吐化疗（MEC）患者的CINV方面带来有临床意义的益处。方法我们对 PubMed、Cochrane Library 和 Ichushi-Web 进行了系统性回顾，以确定评估 NK1RAs 与 5-HT3RAs 和地塞米松联合治疗 MEC CINV 的临床研究。研究终点为完全应答 (CR)、完全控制 (CC)、完全控制 (TC)、不良事件和费用。结果从142篇文章中筛选出15项随机对照试验（RCT）纳入荟萃分析，涉及4405名患者。约60%的患者接受了以卡铂（CBDCA）为基础的化疗。荟萃分析表明，在每个阶段，使用NK1RA进行三联止吐预防对达到CR的效果明显优于双联预防。就CC而言，在总体（风险差异[RD]：0.11，95%置信区间[CI]：0.06-0.17）和延迟（风险差异[RD]：0.08，95%置信区间[CI]：0.02-0.13）阶段，三联止吐预防疗法的效果明显优于双联疗法。至于 TC，在任何阶段均未观察到明显差异。结论在基于CBDCA的化疗中添加NK1RA已显示出临床益处。结论在基于CBDCA的化疗中添加NK1RA已显示出临床益处，但含NK1RA的方案对整体MEC的临床益处尚未确定，需要专门评估基于CBDCA的化疗以外的MEC方案的RCT。

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

International Journal of Clinical Oncology 医学-肿瘤学

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.