帕洛诺司琼预防新辅助化疗治疗骨肉瘤及PNET 患者所致恶心呕吐的临床观察

惠元1，权冬1，苏志1，张维1，曾钦梅1，樊笑1 ，王佳友1，吴智钢1, 2 *

（1.解放军第五一八医院骨科，陕西 西安，710043；2.第四军医大学西京医院骨科，陕西 西安，710032）

浏览次数：141次 下载次数：370次

摘要：

目的 观察新辅助化疗治疗骨肉瘤及原始神经外胚层肿瘤（PNET）患者中，使用盐酸帕洛诺司琼预防化疗引起的急性期和迟发期恶心呕吐的疗效、不良反应及安全性。方法 选取52 例原发恶性骨肿瘤患者（41 例骨肉瘤，11 例PNET），均给予 DA-I 方案（顺铂120 mg/m2，多柔比星60 mg/m2，异环磷酰胺12 g/m2；全身静脉给药）交替行新辅助化疗4 个周期。将所有患 者随机分为试验组（盐酸帕洛诺司琼）和对照组（盐酸托烷司琼），各26 例。比较两组预防控制化疗引起的急性期及迟发期恶 心呕吐总有效率，同时对不良反应进行评价。结果 两组患者均有104 个化疗周期，均可评价疗效。急性期预防呕吐的总有效 率：试验组为96.15%，对照组为92.31% ，组间比较，差异无统计学意义（P>0.05）；迟发期预防呕吐的总有效率：试验组为 92.31%、对照组为65.38%，组间比较，差异有统计学意义（P<0.05）。两组患者均耐受良好，无便秘、腹泻、头痛、乏力、皮疹、呼 吸困难、低血压等明显不良反应。结论 盐酸帕洛诺司琼用于预防新辅助化疗治疗骨肉瘤及PNET 急性期和延迟期恶心呕吐 疗效更确切，安全性良好。

关键词：盐酸帕洛诺司琼；骨肉瘤；PNET；新辅助化疗；恶心呕吐

中图分类号：R730.53文献标志码：A文章编号：2096-1413(2018)03-0027-03

Clinical observation of palonosetron hydrochloride in prevention of nausea and vomiting caused by neoadjuvant chemotherapy in osteosarcoma and PNET patients
HUI Yuan 1, QUAN Dong1, SU Zhi 1, ZHANG Wei 1, ZENG Qin-mei 1, FAN Xiao 1, WANG Jia-you 1, WU Zhi-gang1,2 *

(1. Orthopedics Department, No.518 Hospital of the PLA, Xi``an 710043; 2. Orthopedics Department,
Xijing Hospital of the Fourth Military Medical University, Xi``an 710032, China)

ABSTRACT：Objective To evaluate the efficacy, adverse reactions and safety of palonosetron hydrochloride in preventing acute and delayed period chemotherapy-induced nausea and vomiting in osteosarcoma and PNET patients who underwent neoadjuvant chemotherapy. Methods A total of 52 patients with primary malignant bone tumor were selected, in which, 41 cases were osteosarcoma and 11 cases were PNET. All the patients were given neoadjuvant chemotherapy (DA-I: cisplatin 120 mg/m2, doxorubicin 60 mg/m2, ifosfamide 12 g/m2; systemic intravenous administration) alternatively administrated for 4 cycles. Patients were randomly divided into experimental group (palonosetron hydrochloride) and control group (tropisetron hydrochloride), with 26 cases in each group. The total effective rates of both group in acute period (0～24 h after administration) and delayed period (within 5 d after chemotherapy) were compared, and the adverse reactions were observed. Results Each group had 104 chemotherapy cycles, which could be valid for further evaluation. The total effective rate of prevention vomiting in the acute phase of the experimental group was 96.15%, and the control group was 92.31%, there was no significant different between the two group (P>0.05). The total effective rate of prevention vomiting in delayed phase of the experimental group was 92.31%, which was higher than 65.38% in the control group (P<0.05). Both groups were well tolerated, and there were no constipation, diarrhea, headache, fatigue, rash, dyspnea, hypotension and other obvious adverse reactions. Conclusion Palonosetron hydrochloride is effective and safety in preventing acute and delayed chemotherapy-induced nausea and vomiting in osteosarcoma and PNET patients who underwent neoadjuvant chemotherapy, and has good safety.
KEYWORDS: palonosetron hydrochloride; osteosarcoma; PNET; neoadjuvant chemotherapy; nausea and vomiting

参考文献：
[1] JANELSINS MC,TEJANI MA,KAMEN C,et al.Current pharmacotherapy for chemotherapy -induced nausea and vomiting in cancer patients[J].Expert Opin Pharmacother,2013,14(6):757-766.
[2] ROJAS C,LI Y,ZHANG J,et al.The antiemetic 5-ht3 receptor antagonist palonosetron inhibits substance p-mediated responses in vitro and in vivo[J].J Pharmacol Exp Ther,2010,335(2):362-368.
[3] 赵美琴,张蓓.盐酸帕洛诺司琼防治含顺铂方案化疗所致恶心呕吐的临床观察[J].南通大学学报:医学版,2015,35(6):627-628.
[4] 于小云.盐酸帕洛诺司琼预防肿瘤化疗引起的恶心呕吐的疗效观察[J].中国现代医生,2016,54(6):66-68.
[5] 贾斌,李朝旭,孔祥芸.骨肉瘤的治疗进展[J].中国临床新医学,2016,9(10):941-944.
[6] 闫坤,葛燕燕,李向阳,等.外周性原始神经外胚层肿瘤的诊断及治疗[J].现代肿瘤医学,2016,24(9):1446-1449.
[7] 郭梦瑶,王拥军,杨燕萍.现代医学治疗骨肉瘤现状分析及展望[J].实用医学杂志,2017,33(4):507-509.
[8] EMIR S,ERTURGUT P,VIDINLISAN S.Comparison of granisetron plus dexamethasone versus an antiemetic cocktail containing midazolam and diphenhydramine for chemotherapy induced nausea and vomiting in children [J].Indian J Med Paediatr Oncol,2013,34 (4): 270-273.
[9] 汤丽娜,林峰,姚阳.注射盐酸帕洛诺司琼预防骨肉瘤大剂量化疗引 起胃肠道反应的疗效观察[J].中国肿瘤临床,2013(3):168-170,177.
[10] 张晓丽,许惠丽,赵伟,等.帕洛诺司琼和格拉司琼预防血液肿瘤化 疗所致恶心呕吐的疗效对比观察[J].中国实用医药,2016,11(15):139-140.
[11] BAJWA SS,BAJWA SK,KAUR J,et al.Palonosetron: a novel approach to control postoperative nausea and vomiting in day care surgery[J].Saudi J Anaesth,2011,5(1):19-24.
[12] FABI A,MALAGUTI P.An update on palonosetron hydrochloride for the treatment of radio/chemotherapy -induced nausea and vomiting [J].Expert Opin Pharmacother,2013,14(5):629-641.
[13] NAVARI RM.Prevention of emesis from multiple -day and high -dose chemotherapy regimens[J].J Natl Compr Canc Netw,2007,5(1): 51-59.