化學治療止吐藥之新進展

Update on Antiemetics of Chemotherapy

邱威鑫(Wei-Hsin Chiu) ； 張光裕(Kwang-Yu Chang) ； 陳雅萍(Ya-Ping Chen) ； 林鵬展(Peng-Chan Lin) ； 蘇文彬(Wen-Pin Su) ； 顏家瑞(Chia-Jui Yen) ； 陳彩雲(Tsai-Yun Chen) ； 蘇五洲(Wu-Chou Su)

《內科學誌》 18卷6期 (2007/12) Pp. 342-349

https://doi.org/10.6314/JIMT.2007.18(6).05

摘要

過去二十年來由於許多基礎與臨床的研究，已經使得化學治療病人的噁心和嘔吐獲得成功的控制，而新止吐藥的治療目標就是希望能完全預防化學治療產生的噁心和嘔吐。2003年3月美國食品藥物管理局(Food and Drug Administration (FDA))核准新的止吐藥aprepitrant（一種neurokinin-1(NK1) receptor antagonists）作為預防化學治療產生的的急性及延遲性嘔吐。因此，在最近美國臨床腫瘤學會(American Society of Clinical Oncology (ASCO))和跨國癌症支持性照護協會(Multinational Association of Supportive Care in Cancer (MASCC))也更新了對於化學治療止吐藥的凖則，建議aprepitant 合併5-Hydroxytryptamine3(5-HT3)serotonin receptor antagonist和類固醇(dexamethasone)三種藥物一起使用來預防急性嘔吐的發生，合併使用aprepitant比傳統的兩者合併效果更好。此外，在預防化學治療後的延遲性嘔吐時，合併aprepitant與dexamethasone的效果也比使用傳統的5-HT3 receptor serotonin antagonist來的好。儘管如此，直至目前為止，並非所有癌症化學治療所引發的嘔吐都能夠被預防和治療，我們還是需要有更多的研究，來預防嘔吐的發生。並且期待能發展出更好的止吐療效的藥物。

關鍵字

噁心 ； 嘔吐 ； 止吐藥 ； 5-Hydroxytryptamine3 5-HT3 receptor serotonin antagonist ； Neurokinin-1 NK-1 receptor antagonists

並列摘要

During the past 20 years, nausea and vomiting of the patients who received chemotherapy has been controlled successfully. It is based on many clinical and basic research. The goal of new anti-emetic therapy is to prevent nausea and vomiting completely. Food and drug administration (FDA) has approved aprepitant (neurokinin-1 NK1 receptor antagonist) on March 2003 for prevention of acute and delayed chemotherapy induced nausea and vomiting (CINV) when highly emetogeneic agents are given. The American Society of Clinical Oncology (ASCO) and the Multinational Association of Supportive Care in Cancer (MASCC) have updated guideline recently. The three-drug combination of a 5-hydroxytryptamine-3 (5-HT3) serotonin receptor antagonist, dexamethasone, and aprepitant is recommended for prevention of acute emesis, and it has better response than traditional use of two drug combination. Besides, the 5-HT3 serotonin receptor antagonist is instituted by the two-drug combination of dexamethasone and aprepitant when we choose them for the prevention of delayed emesis of chemotherapy. Not all relevant questions regarding emesis in cancer have been resolved. More research for the prevention of emesis and the development of new agents with better antiemetic effects are encouraged.

並列關鍵字

Nausea ； Vomiting ； Anti-emetic agents ； 5-Hydroxytryptamine3 5-HT3 receptor serotonin antagonist ； Neurokinin-1 NK-1 receptor antagonists