Analiza učinkovitosti antiemetičnega zdravljenja bolnikov s pljučnim rakom, zdravljenih s kemoterapijo na Kliniki Golnik v letu 2017

Čadež, Nika (author), Kerec - Kos, Mojca (mentor), Knez, Lea (co-mentor)

Slabost in bruhanje sta pogosta neželena učinka zdravljenja s kemoterapijo, ki ju lahko preprečimo s predpisom ustreznih antiemetičnih zdravil. Izbira antiemetika je odvisna od kemoterapevtske sheme in značilnosti posameznega bolnika. V zdravljenju uporabljamo glukokortikoide, antagoniste receptorjev za 5-hidoksitriptamin in antagoniste receptorjev za nevrokinin 1 (antagoniste NK1) v različnih kombinacijah. Namen raziskave je bil analizirati učinkovitost antiemetičnega zdravljenja pri bolnikih s pljučnim rakom, ki so se prvič zdravili s kemoterapijo na osnovi spojin platine na Kliniki Golnik v letu 2017. Učinkovitost antiemetičnega zdravljenja smo ocenili kot uspešno v primeru popolnega antiemetičnega odgovora (odsotnost bruhanja ali dodatka novega antiemetika kadarkoli tekom zdravljenja s kemoterapijo). Pri tem smo ločeno obravnavali bolnike, ki so prejeli kemoterapijo s cisplatinom in karboplatinom. V raziskavo smo vključili 98 bolnikov, od tega 78 zdravljenih s cisplatinom in 20 s karboplatinom. Večina (80,8 %; 63/78) bolnikov, zdravljenih s cisplatinom, je prejela dvotirno antiemetično zdravljenje z visokim odmerkom deksametazona in granisetrona, brez antagonista NK1, ki je sicer priporočen v smernicah. Večina (75,0 %; 15/20) bolnikov, zdravljenih s karboplatinom, je prejela dvotirno antiemetično zdravljenje z nizkim odmerkom deksametazona in granisetrona, brez antagonista NK1, ki je sicer priporočen v smernicah. Kljub manj intenzivnemu zdravljenju od priporočenega v smernicah je imelo 76,3 % (71/93) bolnikov popoln antiemetični odgovor, od tega 81,1 % bolnikov s cisplatinom (60/74), kar je primerljivo s podatki v kliničnih raziskavah, kjer so bolniki prejeli bolj intenzivno zdravljenje z antagonistom NK1, vendar le 57,9 % bolnikov s karboplatinom (11/19), kar je slabše od podatkov v kliničnih raziskavah, kjer so bolniki prejeli bolj intenzivno zdravljenje z antagonistom NK1. Pričakovano smo nepopoln antiemetični odgovor bolj pogosto zabeležili pri ženskah, tako v celotni skupini kot v podskupini bolnikov, zdravljenih s cisplatinom. Kljub uporabi manj intenzivnega antiemetičnega zdravljenja od priporočenega v smernicah smo pri podskupini bolnikov z rakom pljuč, zdravljenih s kemoterapijo na osnovi cisplatina, ugotovili primerljivo učinkovitost. Slabši nadzor slabosti in bruhanja pri bolnikih, zdravljenih s kemoterapijo na osnovi karboplatina, pa zahteva razmislek o intenziviranju doslej uporabljenega antiemetičnega zdravljenja.

• Language: Slovenian
• Keywords: bruhanje, kemoterapija, pljučni rak, antiemetiki, antagonisti NK1
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2019
• PID: 20.500.12556/RUL-111801
• Publication date in RUL: 14.10.2019

Secondary language

• Language: English
• Title: Efficacy analysis of antiemetic treatment in lung cancer patients, treated with chemotherapy at the University Clinic Golnik in 2017

Abstract

Nausea and vomiting are frequently reported adverse effects associated with chemotherapy which can be averted by prescription of appropriate antiemetic medications. The choice of antiemetics depends on chemotherapy regimen and the characteristics of the individual patient. In treatment glucocorticoids, antagonists of the receptors for 5-hydroxytryptamine and antagonists of the receptors for neurokinin 1 (NK1 antagonists) in different combinations are used. The purpose of the study was to analyze the antiemetic efficacy of treatment in patients with lung cancer, who were for the first time treated with chemotherapy based on compounds of platinum at the University Clinic Golnik in 2017. The antiemetic efficacy was assessed as effective in the case of complete antiemetic response (absence of emetic episodes or addition of a new antiemetic at any time during treatment with chemotherapy). Patients who received chemotherapy with cisplatin and carboplatin were considered separately. 98 patients were included in the study, 78 treated with cisplatin and 20 with carboplatin. Most patients (80.8 %, 63/78) treated with cisplatin received dual antiemetic treatment with high dose of dexamethasone and granisetron with no NK1 antagonist that is otherwise recommended by the guidelines. Most patients (75.0 %; 15/20) treated with carboplatin received dual antiemetic treatment with low dose of dexamethasone and granisetron with no NK1 antagonist that is otherwise recommended by the guidelines. Despite less intensive treatment than the recommended in the guidelines, 76.3 % (71/93) had complete antiemetic response. 81.1 % of this were patients with cisplatin (60/74), which is comparable to the data from clinical studies, but only 57.9 % patients with carboplatin (11/19). The latter is not as good as in clinical studies, in which patients received more intensive treatment with NK1 antagonist. As expected we received incomplete antiemetic response more frequently in women, both in the whole group and in the group with patients treated with cisplatin. Despite the use of less intense antiemetic treatment than recommended in guidelines we found out comparative efficacy in patients with lung cancer treated with cisplatin–based chemotherapy. Poor nausea and vomiting control in patients treated with carboplatin–based chemotherapy calls for reflection on intensification of antiemetic treatment used so far.

• Keywords: vomiting, chemotherapy, lung cancer, antiemetics, NK1 antagonists