Zusammenfassung
Bei Patienten gelten Übelkeit und Erbrechen nach wie vor zu den unangenehmsten Nebenwirkungen
der Chemotherapie. Das Risiko nach der Chemotherapie zu erbrechen, hängt in erster
Linie von der Emetogenität der einzelnen Chemotherapeutika ab. Durch die Einführung
der Neurokin-1-Rezeptor-Antagonisten wurde eine weitere Verbesserung in der antiemetischen
Prophylaxe erreicht. Durch die Kombination eines 5-HT3-Rezeptorantagonisten mit einem Neurokinin-1-Rezeptor-Antagonisten und einem Steroid
können Übelkeit und Erbrechen inzwischen bei bis zu 70-90 % der Patienten verhindert
werden. In diesem Artikel wird das leitliniengerechte Vorgehen in der antiemetischen
Prophylaxe und Therapie vorgestellt. Zudem werden die verschiedenen Antiemetika praxisnah
beschrieben.
Summary
Nausea and vomiting are considered as two of the most distressing side effects of
chemotherapy. The frequency of nausea and vomiting depends primarily on the emetogenic
potential of the chemotherapeutic agents used. With the introduction of the neurokinin-1-receptor-antagonists
in combination with 5-HT3 receptor-antagonists and steroid approximately 70-90 % of patients receiving highly
emetogenic chemotherapy can be protected from emesis. Here, the most recent developments
in the antiemetic therapy including the latest guidelines for antiemetic prophylaxis
are described.
Schlüsselwörter
Antiemetische Therapie - MASCC-Leitlinien - ASCO-Leitlinien - 5-HT3-Rezeptor-antagonisten - Neurokinin-1-Rezeptor-antagonisten
Key words
Antiemetic therapy - MASCC-guidelines - ASCO-guidelines - 5-HT3 receptor-antagonists - neurokinin-1-receptor-antagonist
Literatur
- 1
Aapro M S.
How do we manage patients with refractory or breakthrough emesis?.
Support Care Cancer.
2002;
10
106-109
- 2 Ettinger D S DD, Kris M G. National Comprehensive Cancer Network: Antiemesis, Clinical
Practice Guidelines in Oncology. 1 ed Jenkintown: NCCN 2005
- 3
Ezzo J M, Richardson M A, Vickers A. et al .
Acupuncture-point stimulation for chemotherapy-induced nausea and vomiting.
Cochrane Datebase Syst Rev.
2006;
19
CD 002285
- 4
Geling O, Eichler H G.
Should 5-hydroxytryptamine-3 receptor antagonists be administered beyond 24 hours
after chemotherapy to prevent delayed emesis? Systematic re-evaluation of clinical
evidence and drug cost implications.
J Clin Oncol.
2005;
23
1289-1294
- 5
Gralla R J, Osoba D, Kris M G. et al .
Recommendations for the use of antiemetics: evidence-based, clinical practice guidelines.
American Society of Clinical Oncology.
J Clin Oncol.
1999;
17
2971-2994
- 6
Grunberg S M, Osoba D, Hesketh P J. et al .
Evaluation of new antiemetic agents and definition of antineoplastic agent emetogenicity
- an update.
Support Care Cancer.
2005;
13
80-84
- 7
Herrstedt J, Koeller J M, Roila F. et al .
Acute emesis: moderately emetogenic chemotherapy.
Support Care Cancer.
2005;
13
97-103
- 8
Hesketh P J, Grunberg S M, Gralla R J. et al .
The oral neurokinin-1 antagonist aprepitant for the prevention of chemotherapy-induced
nausea and vomiting: a multinational, randomized, double-blind, placebo-controlled
trial in patients receiving high-dose cisplatin - the Aprepitant Protocol 052 Study
Group.
J Clin Oncol.
2003;
21
4112-4119
- 9
Holdsworth M T, Vo-Nguyyen T.
Employment of substandard antiemetic prophylaxis in recent trials of chemotherapy-induced
nausea and vomiting.
Ann Pharmacother.
2005;
39
11903-11910
- 10
Jordan K.
Neurokinin-1-receptor antagonists: a new approach in antiemetic therapy.
Onkologie.
2006;
29
39-43
- 11
Jordan K, Kasper C, Schmoll H J.
Chemotherapy-induced nausea and vomiting: current and new standards in the antiemetic
prophylaxis and treatment.
Eur J Cancer.
2005;
41
199-205
- 12
Koeller J M, Aapro M S, Gralla R J. et al .
Antiemetic guidelines: creating a more practical treatment approach.
Support Care Cancer.
2002;
10
519-522
- 13
Kris M G, Hesketh P J, Herrstedt J. et al .
Consensus proposals for the prevention of acute and delayed vomiting and nausea following
high-emetic-risk chemotherapy.
Support Care Cancer.
2005;
13
85-96
- 14
Kris M G, Hesketh P J, Somerfield M R. et al .
American Society of Clinical Oncology Guideline for Antiemetics in Oncology: Update
2006.
J Clin Oncol.
2006;
18
2932-2947
- 15
Oo Th, Hesketh P J.
Drug insight: New antiemetics in the management of chemotherapy-induced nausea and
vomiting.
Nat Clin Pract Oncol.
2005;
2
196-201
- 16
Passik S D, Navari R M, Jung S H. et al .
A phase I trial of olanzapine (Zyprexa) for the prevention of delayed emesis in cancer
patients: a Hoosier Oncology Group study.
Cancer Invest.
2004;
22
383-388
- 17
Roila F, Hesketh P J, Herrstedt J.
Prevention of chemotherapy- and radiotherapy induced emesis: results of the 2004 Perugia
International Antiemetic Consensus Conference.
Ann Oncol.
2006;
17
20-28
- 18
Schmoll H J, Aapro M S, Poli-Bigelli S. et al .
Comparison of an aprepitant regimen with a multiple-day ondansetron regimen, both
with dexamethasone, for antiemetic efficacy in high-dose cisplatin treatment.
Ann Oncol.
2006;
17
1000-1006
Dr. med. Karin Jordan
Klinik für Innere Medizin IV, Hämatologie/Onkologie, Martin-Luther-Universität Halle/Wittenberg
Ernst-Grube-Straße 40
06120 Halle/Saale
Telefon: 0345/5572924
Fax: 0345/5572950
eMail: Karin.jordan@medizin.uni-halle.de