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中华结直肠疾病电子杂志 ›› 2024, Vol. 13 ›› Issue (05) : 353 -361. doi: 10.3877/cma.j.issn.2095-3224.2024.05.001

指南与共识

直肠癌新辅助治疗相关恶心、呕吐副反应的预防、诊断及治疗指南
中国抗癌协会结直肠肿瘤整合康复专业委员会, 北京癌症防治学会直肠癌新辅助治疗专业委员会   
  • 收稿日期:2024-08-12 出版日期:2024-10-25
  • 基金资助:
    中央高水平医院临床科研专项(No. 2022-PUMCH-C-005)

Guidelines on prevention,diagnosis,and treatment of nausea and vomiting caused by neoadjuvant therapies for rectal cancer

Anti-cancer Association Colorectal Tumor Integrated Rehabilitation Committee, Neoadjuvant Therapy for Rectal Cancer Professional Committee of Beijing Cancer Prevention & Treatment Society Chinese   

  • Received:2024-08-12 Published:2024-10-25
引用本文:

中国抗癌协会结直肠肿瘤整合康复专业委员会, 北京癌症防治学会直肠癌新辅助治疗专业委员会. 直肠癌新辅助治疗相关恶心、呕吐副反应的预防、诊断及治疗指南[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 353-361.

Anti-cancer Association Colorectal Tumor Integrated Rehabilitation Committee, Neoadjuvant Therapy for Rectal Cancer Professional Committee of Beijing Cancer Prevention & Treatment Society Chinese. Guidelines on prevention,diagnosis,and treatment of nausea and vomiting caused by neoadjuvant therapies for rectal cancer[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2024, 13(05): 353-361.

新辅助治疗是局部进展期中低位直肠癌的标准治疗。近年来,全程新辅助治疗(TNT)、新辅助免疫治疗等治疗模式的探索使新辅助治疗的疗效不断提高,但治疗相关的恶心、呕吐仍然常见,不仅会影响患者的生活质量,还会降低治疗依从性,尤其在全程新辅助治疗等长疗程治疗时,可能导致治疗延迟或中断,严重影响治疗效果。目前,针对直肠癌新辅助治疗相关的恶心、呕吐副反应的预防、诊断及治疗尚缺乏专业规范的临床指南和专家共识。为此,中国抗癌协会结直肠肿瘤整合康复专业委员会和北京癌症防治学会直肠癌新辅助治疗专业委员会组织专家,整合近年来相关研究进展,遵循国内外循证医学证据,参考现有抗肿瘤治疗相关恶心、呕吐治疗指南及专家共识,结合临床实践,经反复研讨,共同制定了直肠癌新辅助治疗相关恶心、呕吐副反应的预防、诊断及治疗指南,该指南旨在为接受直肠癌新辅助治疗出现恶心、呕吐相关副反应的患者提供预防诊断和治疗等方面的专业指导和建议,以期提高新辅助治疗效果,从而改善患者的生活质量和治疗预后。

Neoadjuvant radiochemotherapy is the standard treatment for locally advanced rectal cancer. In recent years,the exploration of treatment modalities such as total neoadjuvant therapy(TNT)and neoadjuvant immunotherapy has led to the continuous improvement of the efficacy of neoadjuvant therapy,but treatment-related nausea and vomiting are still common,which not only affects the quality of life,but also reduces the adherence to the treatment,especially in the case of a long course of treatment such as the total neoadjuvant therapy,which may lead to delayed or interrupted treatment and seriously affects the effectiveness of the treatment. At present,there is a lack of specialized guidelines for the prevention,diagnosis,and treatment of nausea and vomiting associated with neoadjuvant therapy for rectal cancer. For this reason,the Chinese Anti-cancer Association Colorectal Tumor Integrated Rehabilitation Committee and Beijing Cancer Prevention & Treatment Society have organized experts to consolidate the relevant research progress in recent years,follow the evidence of domestic and international evidence-based medical science,refer to the existing guidelines and experts' consensus,and combine with the clinical practice. The guideline aims to provide professional guidance and suggestions for the prevention and treatment of nausea and vomiting side effects associated with neoadjuvant therapy for rectal cancer,to improve the prognosis and quality of life of patients and therapeutic effect.

表1 指南证据级别与推荐强度
表2 化疗相关恶心、呕吐副反应分类
表3 常见直肠癌新辅助放化疗方案与出现恶心、呕吐副反应预防性用药方案
表4 常用止吐药物种类及使用方案
[1]
Li Y,Wang J,Ma X,et al. A review of neoadjuvant chemoradiotherapy for locally advanced rectal cancer[J]. Int J Biol Sci,2016,12(8):1022-1031.
[2]
Becht E,de Reyniès A,Giraldo NA,et al. Immune and stromal classification of colorectal cancer is associated with molecular subtypes and relevant for precision immunotherapy[J]. Clin Cancer Res,2016,22(16): 4057-4066.
[3]
Kagawa Y,Smith JJ,Fokas E,et al. Future direction of total neoadjuvant therapy for locally advanced rectal cancer[J]. Nat Rev Gastroenterol Hepatol,2024,21(6): 444-455.
[4]
Saraf A,Roberts HJ,Wo JY,et al. Optimal neoadjuvant strategies for locally advanced rectal cancer by risk assessment and tumor location[J]. J Natl Compr Canc Netw,2022,20(10): 1177-1184.
[5]
Dossa F,Chesney TR,Acuna SA,et al. A watch-and-wait approach for locally advanced rectal cancer after a clinical complete response following neoadjuvant chemoradiation: a systematic review and metaanalysis[J]. Lancet Gastroenterol Hepatol,2017,2(7): 501-513.
[6]
Guyatt G,Oxman AD,Akl EA,et al. GRADE guidelines: 1.introduction-GRADE evidence profiles and summary of findings tables[J]. J Clin Epidemiol,2011,64(4): 383-394.
[7]
U.S. Department of health and human services. National institutes of health. national cancer institute. Common terminology criteria for adverse events Version 5.0 [EB/OL]. [2017-11-27] (2024-08-12)https://www.meddra.org/.
[8]
China Anti-Cancer Association Committee of Rehabilitation and Palliative Care,China Anti-Cancer Association Committee of Tumor Clinical Chemotherapy,China Anti-Cancer Association Committee of Neoplastic Supportive-Care,et al. China guidelines on prevention and treatment of nausea and vomiting caused by antitumor therapies (2023 edition)[J]. Chin J Oncol,2024,46(6):481-501.
[9]
Molassiotis A,Lee PH,Burke TA,et al. Anticipatory nausea,risk factors,and its impact on chemotherapy-induced nausea and vomiting:results from the pan European emesis registry study[J]. J Pain Symptom Manage,2016,51(6): 987-993.
[10]
Chan A,Kim HK,Hsieh RK,et al. Incidence and predictors of anticipatory nausea and vomiting in Asia Pacific clinical practice--a longitudinal analysis[J]. Support Care Cancer,2015,23(1): 283-291.
[11]
Roscoe JA,Bushunow P,Morrow GR,et al. Patient expectation is a strong predictor of severe nausea after chemotherapy: a university of rochester community clinical oncology program study of patients with breast carcinoma[J]. Cancer,2004,101(11): 2701-2708.
[12]
Hayashi T,Shimokawa M,Matsuo K,et al. 5HT3 RA plus dexamethasone plus aprepitant for controlling delayed chemotherapyinduced nausea and vomiting in colorectal cancer[J]. Cancer Sci,2021,112(2): 744-750.
[13]
Matsui R,Suzuki K,Takiguchi T,et al. 5-Hydroxytryptamine-3 receptor antagonist and dexamethasone as prophylaxis for chemotherapy-induced nausea and vomiting during moderately emetic chemotherapy for solid tumors: a multicenter,prospective,observational study[J]. BMC Pharmacol Toxicol,2020,21(1): 72
[14]
Warr D. Prognostic factors for chemotherapy induced nausea and vomiting[J]. Eur J Pharmacol,2014,722: 192-196.
[15]
Molassiotis A,Aapro M,Dicato M,et al. Evaluation of risk factors predicting chemotherapy-related nausea and vomiting: results from a European prospective observational study[J]. J Pain Symptom Manage,2014,47(5): 839-848. e4.
[16]
Kamen C,Tejani MA,Chandwani K,et al. Anticipatory nausea and vomiting due to chemotherapy[J]. Eur J Pharmacol,2014,722: 172-179.
[17]
Roila F,Herrstedt J,Aapro M,et al. Guideline update for MASCC and ESMO in the prevention of chemotherapy- and radiotqwherapyinduced nausea and vomiting: results of the Perugia consensus conference[J]. Ann Oncol,2010,21(Suppl 5): v232-v243.
[18]
Body A,Prenen H,Lam M,et al. Neoadjuvant therapy for locally advanced rectal cancer: recent advances and ongoing challenges[J].Clin Colorectal Cancer,2021,20(1): 29-41.
[19]
Hofheinz RD,Wenz F,Post S,et al. Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised,multicentre,non-inferiority,phase 3 trial[J]. Lancet Oncol,2012,13(6): 579-588.
[20]
Allegra CJ,Yothers G,O'Connell MJ,et al. Neoadjuvant 5-fu or capecitabine plus radiation with or without oxaliplatin in rectal cancer patients: a phase III randomized clinical trial[J]. J Natl Cancer Inst,2015,107(11): djv248.
[21]
Zhao L,Liu R,Zhang Z,et al. Oxaliplatin/fluorouracil-based adjuvant chemotherapy for locally advanced rectal cancer after neoadjuvant chemoradiotherapy and surgery: a systematic review and meta-analysis of randomized controlled trials[J]. Colorectal Dis,2016,18(8): 763-772.
[22]
Wong SJ,Winter K,Meropol NJ,et al. Radiation Therapy Oncology Group 0247: a randomized Phase II study of neoadjuvant capecitabine and irinotecan or capecitabine and oxaliplatin with concurrent radiotherapy for patients with locally advanced rectal cancer[J]. Int J Radiat Oncol Biol Phys,2012,82(4): 1367-1375.
[23]
Deng Y,Chi P,Lan P,et al. Modified FOLFOX6 with or without radiation versus fluorouracil and leucovorin with radiation in neoadjuvant treatment of locally advanced rectal cancer: initial results of the Chinese FOWARC multicenter,open-label,randomized threearm phase III trial[J]. J Clin Oncol,2016,34(27): 3300-3307.
[24]
Zhu J,Liu A,Sun X,et al. Multicenter,randomized,phase III trial of neoadjuvant chemoradiation with capecitabine and irinotecan guided by UGT1A1 status in patients with locally advanced rectal cancer[J]. J Clin Oncol,2020,38(36): 4231-4239.
[25]
Ansari N,Solomon MJ,Fisher RJ,et al. Acute adverse events and postoperative complications in a randomized trial of preoperative short-course radiotherapy versus long-course chemoradiotherapy for T3 adenocarcinoma of the rectum: Trans-Tasman Radiation Oncology Group Trial (TROG 01.04)[J]. Ann Surg,2017,265(5): 882-888.
[26]
Fernández-Martos C,Pericay C,Aparicio J,et al. Phase II,randomized study of concomitant chemoradiotherapy followed by surgery and adjuvant capecitabine plus oxaliplatin (CAPOX) compared with induction CAPOX followed by concomitant chemoradiotherapy and surgery in magnetic resonance imaging-defined,locally advanced rectal cancer: Grupo cancer de recto 3 study[J]. J Clin Oncol,2010,28(5): 859-865.
[27]
Sclafani F,Brown G,Cunningham D,et al. PAN-EX: a pooled analysis of two trials of neoadjuvant chemotherapy followed by chemoradiotherapy in MRI-defined,locally advanced rectal cancer[J]. Ann Oncol,2016,27(8): 1557-1565.
[28]
Conroy T,Bosset JF,Etienne PL,et al. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23):a multicentre,randomised,open-label,phase 3 trial[J]. Lancet Oncol,2021,22(5): 702-715.
[29]
Garcia-Aguilar J,Chow OS,Smith DD,et al. Effect of adding mFOLFOX6 after neoadjuvant chemoradiation in locally advanced rectal cancer: a multicentre,phase 2 trial[J]. Lancet Oncol,2015,16(8):957-966.
[30]
Bahadoer RR,Dijkstra EA,van Etten B,et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy,TME,and optional adjuvant chemotherapy in locally advanced rectal cancer(RAPIDO): a randomised,open-label,phase 3 trial[J]. The Lancet Oncol,2021,22(1): 29-42.
[31]
Jin J,Tang Y,Hu C,et al. Multicenter,randomized,phase III trial of short-term radiotherapy plus chemotherapy versus long-term chemoradiotherapy in locally advanced rectal cancer (STELLAR)[J]. J Clin Oncol,2022,40(15): 1681-1692.
[32]
Fokas E,Allgäuer M,Polat B,et al. Randomized phase II trial of chemoradiotherapy plus induction or consolidation chemotherapy as total neoadjuvant therapy for locally advanced rectal cancer: CAO/ARO/AIO-12[J]. J Clin Oncol,2019,37(34): 3212-3222.
[33]
Boutros C,Tarhini A,Routier E,et al. Safety profiles of anti-CTLA-4 and anti-PD-1 antibodies alone and in combination[J]. Nat Rev Clin Oncol,2016,13(8): 473-486.
[34]
Liu K,Wang YH,Luo N,et al. Treatment-related gastrointestinal adverse events of nivolumab plus ipilimumab in randomized clinical trials: a systematic review and meta-analysis[J]. Future Oncol,2023,19(27): 1865-1875.
[35]
Abdel-Rahman O. Neurokinin-1 inhibitors in the prevention of nausea and vomiting from highly emetogenic chemotherapy: a network metaanalysis[J]. Ther Adv Med Oncol,2016,8(5): 396-406.
[36]
Nakade S,Ohno T,Kitagawa J,et al. Population pharmacokinetics of aprepitant and dexamethasone in the prevention of chemotherapyinduced nausea and vomiting[J]. Cancer Chemother Pharmacol,2008,63(1): 75-83.
[37]
Natale JJ,Spinelli T,Calcagnile S,et al. Drug-drug interaction profile of components of a fixed combination of netupitant and palonosetron:review of clinical data[J]. J Oncol Pharm Pract,2016,22(3): 485-495.
[38]
Herman JM,Narang AK,Griffith KA,et al. The quality-of-life effects of neoadjuvant chemoradiation in locally advanced rectal cancer[J]. Int J Radiat Oncol Biol Phys,2013,85(1): e15-e19.
[39]
Nishimura J,Satoh T,Fukunaga M,et al. Combination antiemetic therapy with aprepitant/fosaprepitant in patients with colorectal cancer receiving oxaliplatin-based chemotherapy (SENRI trial): a multicentre,randomised,controlled phase 3 trial[J]. Eur J Cancer,2015,51(10):1274-1282.
[40]
Scotté F,Schwartzberg L,Iihara H,et al. 2023 updated MASCC/ESMO Consensus recommendations: prevention of nausea and vomiting following moderately emetic risk antineoplastic agents[J].Support Care Cancer,2023,32(1): 45.
[41]
Iihara H,Abe M,Wada M,et al. 2023 Japan Society of clinical oncology clinical practice guidelines update for antiemesis[J]. Int J Clin Oncol,2024,29(7): 873-888.
[42]
NCCN clinical practice guidelines in oncology. Antiemesis[EB/OL].Version 1 2024.[2023-12-13](2024-08-12)https://www.nccn.org/guidelines/guidelines-detail?category=3&id=1415.
[43]
Iihara H,Ishihara M,Fujii H,et al. Comparison of the control of nausea and vomiting among several moderately emetic-risk chemotherapy regimens[J]. J Cancer,2016,7(5): 569-575.
[44]
Tsuji Y,Baba H,Takeda K,et al. Chemotherapy-induced nausea and vomiting (CINV) in 190 colorectal cancer patients: a prospective registration study by the CINV study group of Japan[J]. Expert Opin Pharmacother,2017,18(8): 753-758.
[45]
Hesketh PJ,Wright O,Rosati G,et al. Single-dose intravenous casopitant in combination with ondansetron and dexamethasone for the prevention of oxaliplatin-induced nausea and vomiting: a multicenter,randomized,double-blind,active-controlled,two arm,parallel group study[J]. Support Care Cancer,2012,20(7): 1471-1478.
[46]
Wang DS,Hu MT,Wang ZQ,et al. Effect of aprepitant for the prevention of chemotherapy-induced nausea and vomiting in women: a randomized clinical trial[J]. JAMA Netw Open,2021,4(4): e215250.
[47]
Tan L,Liu J,Liu X,et al. Clinical research of Olanzapine for prevention of chemotherapy-induced nausea and vomiting[J]. J Exp Clin Cancer Res,2009,28(1): 131.
[48]
Jeon SY,Han HS,Bae WK,et al. A randomized,double-blind,placebo-controlled study of the safety and efficacy of olanzapine for the prevention of chemotherapy-induced nausea and vomiting in patients receiving moderately emetogenic chemotherapy: results of the Korean South West Oncology Group (KSWOG) study[J]. Cancer Res Treat,2019,51(1): 90-97.
[49]
Hoffmann MS,Overman MJ,Nates JL. Acute benzodiazepine toxicity exacerbated by concomitant oral olanzapine[J]. J Community Support Oncol,2016,14(4): 178-179.
[50]
Adel N. Overview of chemotherapy-induced nausea and vomiting and evidence-based therapies[J]. Am J Manag Care,2017,23(14 Suppl):S259-S265.
[51]
Marx W,Kiss N,McCarthy AL,et al. Chemotherapy-induced nausea and vomiting: a narrative review to inform dietetics practice[J]. J Acad Nutr Diet,2016,116(5): 819-827.
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