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‚Ŗ‚ń–ņ•Ø—Ć–@‚šs‚¤ˆć—ĆŽŅ‚Ģstate-of-the-art ‚ĶCÅ“K‚ČŽ”—Ć•ūj‚Ģ‚ą‚Ę‚É“KŲ‚Č–ņ•Ø—Ć–@‚š‘I‘š‚µCˆĄ‘S‚ɁC‹ź’É‚ĘŒćˆāĒ‚šÅ¬ŒĄ‚É‚µ‚Č‚Ŗ‚ēCŽ”—Ć‹­“x‚šˆŪŽ‚µ‚ÄÅ‘åŒĄ‚ĢŒų‰Ź‚š“±‚­‚±‚Ę‚Å‚ ‚éBŠe‚Ŗ‚ńŽķ‚ɂ؂Ƃ鎔—ĆƒKƒCƒhƒ‰ƒCƒ“‚Ŗ®”õ‚³‚źCCancer Board ‚ą[ŽĄ‚µ‚Ä‚«‚½‚±‚Ę‚ÅC“KŲ‚Č–ņ•Ø—Ć–@‚Ģ‘I‘š‚Ŗ—eˆÕ‚É‚Č‚³‚ź‚é‚ꂤ‚É‚Č‚Į‚½B‚³‚ē‚ÉŠeŽ{Ż“ą‚Å‚Ķ–ņ•Ø—Ć–@‚ĢƒŒƒWƒƒ“‚š“o˜^§‚É‚µ‚ÄŠĒ—‚·‚é‚ꂤ‚É‚Č‚čC“dŽqƒJƒ‹ƒe‚Ģ•‹y‚É‚ę‚鎩“®ŒvŽZ‚ą“±“ü‚³‚źCˆ•ū‚ÉŽŠ‚é‚Ü‚Å‚Ķˆź”Ź‰»‚³‚źˆĄ‘S«‚ą’S•Ū‚³‚ź‚Ä‚«‚Ä‚¢‚éB‚µ‚©‚µC“Š—^Œć‚Ģ”½‰ž‚É‚ĶŒĀ‘Ģ·‚Ŗ‚ ‚čC•›ģ—p‚Ę‚µ‚ďoŒ»‚·‚é‹ź’É‚É‘Ī‚µ‚Ä‚Ķ‚³‚ē‚ÉŒĀ•Ź‚Ģ‘Ī‰ž‚É‚Č‚é‚½‚߁CŠeŽķŽxŽ—Ć–@‚Ķn’m‚µ‚Ä‚Ø‚­•K—v‚Ŗ‚ ‚éB‚Ŗ‚ń–ņ•Ø—Ć–@‚É‚ę‚Į‚Ä”­Œ»‚·‚鈫SEšq“fichemotherapy-induced nausea and vomiting; CINVj‚ĶCĆ“f‚Ģ‹@˜‚Ŗ‰š–¾‚³‚źC‚»‚±‚ɍģ—p‚·‚é–ņÜ‚ŖŠJ”­‚³‚ź‚½Œ»ó‚É‚Ø‚¢‚Ä‚ąCŠ³ŽŅ‚Ŗ‹ź’É‚ĘŠ“‚¶‚é‘ć•\“I‚Č•›ģ—p‚Å‚ ‚邽‚߁C‚±‚ź‚š“KŲ‚ɐ§Œä‚·‚邱‚Ę‚Ķd—v‚ČˆÓ–”‚š‚ą‚ĀB‚ķ‚Ŗ‘‚Å‚ĶCŠCŠO‚ĢƒKƒCƒhƒ‰ƒCƒ“‚šŽQl‚ɁCŒ»ó‚É‘¦‚µ‚½ƒKƒCƒhƒ‰ƒCƒ“‚šģ¬‚µC•]‰æ‚ąs‚Č‚Į‚Ä‚«‚½1, 2)B‚Ģ“oź‚āV‚½‚Ȑ§“f‚ÉŠÖ‚·‚éƒGƒrƒfƒ“ƒX‚ĢVo‚Ŗ‚ ‚čC‚±‚ź‚ē‚šŠÜ‚ß‚½§“f–ņ“K³Žg—pƒKƒCƒhƒ‰ƒCƒ“2015 ”N10 ŒŽi‘ę2 ”Łjˆź•”‰ü’ł”Łiver.2.2j‚ĢŒöŠJ‚ÉŽŠ‚Į‚½B

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ˆ«SEšq“f‚ĶC}1iR‚Ŗ‚ń–ņ‚É‚ę‚鈫SEšq“f‚ĢƒƒJƒjƒYƒ€j‚ÉŽ¦‚·‚ꂤ‚ɁCć•”Į‰»ŠĒ‚É—DˆŹ‚É‘¶Ż‚·‚é5-HT3Žó—e‘Ģ‚Ę‘ę4 ”]Žŗ‚Ģchemoreceptor trigger zoneiCTZj‚É‘¶Ż‚·‚éNK1Žó—e‘Ģ, ƒhƒpƒ~ƒ“D2Žó—e‘Ģ‚Ŗ•”‡“I‚ÉŽhŒƒ‚³‚źC‰„‘‚Ģšq“f’†•‚Ŗ‹»•±‚·‚邱‚Ę‚Åˆ«S‚šŠ“‚¶C‚³‚ē‚ɉ“S«‚É‘ŸŠķ‚Ģ”½‰ž‚Ŗ‹N‚±‚邱‚Ę‚Åšq“f‚·‚é‚ʍl‚¦‚ē‚ź‚Ä‚¢‚éB‰»ŠwŽó—e‘Ģ‚ōģ—p‚·‚é_Œo“`’B•ØŽæ‚Ę‚µ‚Ä‚ĶCƒZƒƒgƒjƒ“CƒTƒuƒXƒ^ƒ“ƒXPCƒhƒpƒ~ƒ“‚Č‚Ē‚Ŗ’m‚ē‚ź‚Ä‚Ø‚čC‚±‚ź‚ē‚ʝhR‚·‚é–ņÜ‚Č‚Ē‚Ŗ§“f–ņ‚Ę‚µ‚Ä—p‚¢‚ē‚ź‚Ä‚¢‚éi•\1: –{ƒKƒCƒhƒ‰ƒCƒ“‚ÅŽę‚čć‚°‚ē‚ź‚Ä‚¢‚鐧“f–ņˆź——jB‚Ü‚½C”­Œ»‚Ģó‘Ō‚É‚ę‚čˆČ‰ŗ‚Ģ‚ꂤ‚Č•Ŗ—Ž‚Ŗ‚ ‚čCŠeCQ ‚É‚Ż‚é‚ꂤ‚ɁC‹@˜‚ā”wŒi‚šl—¶‚µ‚½‘Ī‰ž‚Ŗs‚ķ‚ź‚Ä‚¢‚éB

  • “Š—^Œć24 ŽžŠŌˆČ“ą‚ɏoŒ»‚·‚é‹}«‚Ģˆ«SEšq“fiacute emesisjØCQ2
  • 24 ŽžŠŌŒć‚©‚ē–ń1 TŠŌ’ö“xŽ‘±‚·‚é’x”­«‚Ģˆ«SEšq“fidelayed emesisjØCQ3
  • §“f–ņ‚Ģ—\–h“I“Š—^‚É‚ą‚©‚©‚ķ‚ē‚ø”­Œ»‚·‚é“Ėo«ˆ«SEšq“fibreakthrough nausea and vomitingjØCQ6
  • R‚Ŗ‚ń–ņ‚Ģ‚±‚Ę‚šl‚¦‚½‚¾‚Æ‚Å—U”­‚³‚ź‚é—\Šś«ˆ«SEšq“fianticipatory nausea and vomitingjØCQ9
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•Ŗ@—Ž –ņÜ–¼ ÜŒ` –{–M³”F—p—Ź ŽQlCQ
•›t”ēŽæƒXƒeƒƒCƒh ƒfƒLƒTƒƒ^ƒ]ƒ“ ’ŽĖÜ 1 “ś3.3`16.5 mg ‚š1`2 ‰ń‚É•ŖŠ„‚µ‚ĐƒC“_“HĆ’** 1C2C3C4C
5C6C7C10C
14C17
łÜ 1“ś4`20 mg‚š1`2‰ń‚É•ŖŠ„‚µ‚ÄŒoŒū
ƒƒ`ƒ‹ƒvƒŒƒhƒjƒ]ƒƒ“ ’ŽĖÜ 250 mg ‚š1 “ś2 ‰ń“_“HĆ’ 1C2C3C5C
6C14
5-HT3Žó—e‘ĢhR–ņ
i‘ęˆź¢‘ćj
ƒAƒUƒZƒgƒƒ“ ’ŽĖÜ 10 mgi‰–Ž_‰–‚Ę‚µ‚āj‚š1 “ś1 ‰ńĆ’*** 1C2C3C4C
5C6C10C14C
16C18
łÜ 10`15 mgi‰–Ž_‰–‚Ę‚µ‚āj‚š1 “ś1 ‰ńŒoŒū
ƒCƒ“ƒWƒZƒgƒƒ“ łÜ 8 mgi‰–Ž_‰–‚Ę‚µ‚āj‚š1 “ś1 ‰ńŒoŒū
ƒIƒ“ƒ_ƒ“ƒZƒgƒƒ“ ’ŽĖÜ 4 mg ‚š1 “ś1 ‰ńŠÉ™‚ɐƒ***
łÜ 4 mg ‚š1 “ś1 ‰ńŒoŒū
Œų‰Ź•s\•Ŗ‚É‚Ķ“Æ—p—Ź‚Ģ’ŽĖ‰t‚šĆ’
ƒOƒ‰ƒjƒZƒgƒƒ“ ’ŽĖÜ 40ƒŹg/kg ‚š1 “ś1 ‰ńĆ’C“_“HĆ’***
łÜ 2 mg ‚š1 “ś1 ‰ńŒoŒū
ƒ‰ƒ‚ƒZƒgƒƒ“ ’ŽĖÜ 0.3 mgi‰–Ž_‰–‚Ę‚µ‚āj‚š1 “ś1 ‰ńĆ’***
łÜ 0.1 mgi‰–Ž_‰–‚Ę‚µ‚āj‚š1 “ś1 ‰ńŒoŒū
i‘ę“ń¢‘ćj ƒpƒƒmƒZƒgƒƒ“ ’ŽĖÜ 0.75 mg ‚š1 ‰ńĆ’‚Ü‚½‚Ķ“_“HĆ’  
NK1Žó—e‘ĢhR–ņ ƒAƒvƒŒƒsƒ^ƒ“ƒg ƒJƒvƒZƒ‹Ü 1 “ś–Ś125 mg ‚šC2 “ś–ŚˆČ~‚Ķ80 mg ‚š1 “ś1 ‰ńŒoŒū 2C3C4C5C
8C14C16C17C
18
ƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒg ’ŽĖÜ 150 mg‚š1“ś–Ś‚É1‰ń“_“HĆ’
ƒhƒpƒ~ƒ“D2Žó—e‘Ģ
hR–ņ
ƒhƒ“ƒyƒŠƒhƒ“ łÜ 10 mg ‚š1 “ś3 ‰ńH‘OŒoŒū 2C6C10C18
æÜ 60 mg ‚š1 “ś2 ‰ń’¼’°“ą
ƒƒgƒNƒƒvƒ‰ƒ~ƒh ’ŽĖÜ 7.67 mg ‚š1 “ś1`2 ‰ń‹Ų’CĆ’ 1C2C3C6C
7C10C18
łÜ 1“ś7.67`23.04 mg‚š2`3‰ń‚É•ŖŠ„‚µ‚ĐH‘OŒoŒū
ƒxƒ“ƒ]ƒWƒAƒ[ƒsƒ“Œn
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ƒAƒ‹ƒvƒ‰ƒ]ƒ‰ƒ€ łÜ 0.4`0.8 mg ‚šŽ”—Ć‘O–é‚Ę“–“ś’©iŽ”—Ć‚Ģ1`2ŽžŠŌ‘Oj‚ÉŒoŒū 6C9
ƒƒ‰ƒ[ƒpƒ€ łÜ 0.5`1.5 mg ‚šŽ”—Ć‘O–é‚Ę“–“ś’©iŽ”—Ć‚Ģ1`2ŽžŠŌ‘Oj‚ÉŒoŒū 1C2C6C9
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ƒvƒƒNƒƒ‹ƒyƒ‰ƒWƒ“ ’ŽĖÜ 5 mg ‚š1 “ś1 ‰ń‹Ų’ 1C2C6C7C
10C18
łÜ 1“ś5`20 mg‚š1`4‰ń‚É•ŖŠ„‚µ‚ÄŒoŒū
ƒNƒƒ‹ƒvƒƒ}ƒWƒ“ ’ŽĖÜ 10`50 mgi‰–Ž_‰–‚Ę‚µ‚āj‚šŠÉ™‚É‹Ų’ 18
łÜ 1 “ś25`75 mgi‰–Ž_‰–‚Ę‚µ‚āj‚š2`3 ‰ń‚É•ŖŠ„‚µ‚ÄŒoŒū
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iƒhƒpƒ~ƒ“D2Žó—e‘ĢhRģ—pj
ƒnƒƒyƒŠƒh[ƒ‹ ’ŽĖÜ 0.5`2 mg ‚š4`6 ŽžŠŌ‚²‚ʂɐƒ 1C2C6C18
łÜ 0.5`2 mg ‚š4`6 ŽžŠŌ‚²‚Ę‚ÉŒoŒū
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iƒhƒpƒ~ƒ“D2Žó—e‘ĢhRģ—pj
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‰tÜ
1.0`1.5 mg ‚š1 “ś1 ‰ń–°‘O‚ÉŒoŒū 2C18
‘½Žó—e‘Ģģ—pRø_•a–ņ
iƒhƒpƒ~ƒ“D2EƒqƒXƒ^ƒ~ƒ“H1E
5-HT3EŽó—e‘ĢhRģ—pj
ƒIƒ‰ƒ“ƒUƒsƒ“ łÜ 5`10 mg ‚š1 “ś1 ‰ńŒoŒū 2C3C6C18
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ƒNƒƒ‹ƒtƒFƒjƒ‰ƒ~ƒ“ ’ŽĖÜ 5 mgiƒ}ƒŒƒCƒ“Ž_‰–‚Ę‚µ‚āj‚š1 “ś3`4 ‰ńĆ’C”ē‰ŗ’ 18
ŽUÜ 2`6 mgiƒ}ƒŒƒCƒ“Ž_‰–‚Ę‚µ‚āj‚š1 “ś2`4 ‰ńŒoŒū

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*’ŽĖ–ņ’†‚ĢŠÜ—Ź‚ĶƒfƒLƒTƒƒ^ƒ]ƒ“3.3 mg/mLCƒŠƒ“Ž_ƒfƒLƒTƒƒ^ƒ]ƒ“ƒiƒgƒŠƒEƒ€4 mg/mL ‚Å‚ ‚éB
**Œų‰Ź•s\•Ŗ‚É‚Ķ“Æ—p—Ź‚š’Ē‰Į“Š—^‰ĀB

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  6. •śŽĖüŽ”—Ć‚ā‚Ŗ‚ń–ņ•Ø—Ć–@‚Ę‚Ķ–³ŠÖŒW‚Ģˆ«SEšq“f‚É‘Ī‚µ‚Ä‚ą§“f—Ć–@‚šs‚¤
  7. ‘½Ü•¹—p—Ć–@‚É‚Ø‚¢‚Ä‚ĶÅ‚ąĆ“f«ƒŠƒXƒN‚Ģ‚‚¢–ņÜ‚É‘Ī‚·‚鐧“f—Ć–@‚š‘I‘š‚·‚é
  8. Å¬“xƒŠƒXƒNR‚Ŗ‚ń–ņ‚Ģ“Š—^ŽžC‹¹‚ā‚Æ‚āĮ‰»•s—ĒĒó‚Ģ‘i‚¦‚É‘Ī‚µ‚Ä‚ĶCH2Žó—e‘ĢhR–ņC‚Ü‚½‚Ķƒvƒƒgƒ“ƒ|ƒ“ƒv‘jŠQ–ņ‚šl—¶‚·‚é
  9. Ž©ŒČŠĒ—‚ÉŠÖ‚·‚銳ŽŅ‹³ˆēEŽw“±
    • ‰ä–‚µ‚Č‚¢‚±‚Ę‚šŠÜ‚ß‚½Š³ŽŅŽ©g‚É‚ę‚éƒZƒ‹ƒtƒAƒZƒXƒƒ“ƒg‚Ģ”FŽÆ‚ʁCŠ³ŽŅ“ś‹L“™‚É‚ę‚é‹L˜^‚Ģ„i‚ÉŠÖ‚·‚鋳ˆē
    • Ž©‘ī‚É‚Ø‚Æ‚éC’芜“I‚Ȑ§“f–ņ‚ĢƒAƒhƒqƒAƒ‰ƒ“ƒXˆŪŽ‚ʁC“Ė”­“I‚Čˆ«SEšq“f‚Ö‚Ģ‘Ī‰ž‚ÉŠÖ‚·‚éŽw“±
  10. ¶ŠˆEŠĀ‹«‚É‚Ø‚Æ‚éH•v‚ā®”õ
    • ‚ä‚Į‚½‚č‚Ę‚µ‚½•ž‘•
    • H¶Šˆ‚Ģ–Ź‚Å‚ĶC­—Ź‚ø‚Ā‰ń”‚š‘‚ā‚·CH‚ׂā‚·‚¢«ó‚É‚·‚éC‚É‚Ø‚¢E–”•t‚ƁE‰·“x“™‚Ģ”z—¶‚āCó‹µ‚ɉž‚¶‚½HŽ–Žw“±E‰h—{Žw“±‚É‚ę‚é‰h—{ŠĒ—‚Ģ“O’ź
    • ŠO—ˆŽ”—ĆŽŗ‚āŽ©‘ī‚É‚Ø‚Æ‚é‚É‚Ø‚¢‚āŠ·‹C“™‚ĢŽ”—ĆŠĀ‹«E¶ŠˆŠĀ‹«‚Ģ®”õ‚Ę”z—¶
  11. ‚Ŗ‚ńŽ”—Ć‚ĢˆźŠĀ‚Ę‚µ‚čs‚ķ‚ź‚Ä‚Ø‚čCź–含‚š‚‚ß‚½‘½EŽķ˜AŒg‚Ģƒ`[ƒ€ˆć—Ć‚Å‚ĢŽĄŽ{‚Ŗd—v
3j–{ƒKƒCƒhƒ‰ƒCƒ“‚š—p‚¢‚½§“f—Ć–@

i1jˆ«SEšq“f‚É‘Ī‚·‚郊ƒXƒN‚Ģ”cˆ¬

① R‚Ŗ‚ń–ņ‚É‚Ø‚Æ‚éĆ“f«ƒŠƒXƒN•]‰æ

‚Ŗ‚ń–ņ•Ø—Ć–@‚Å—U”­‚³‚ź‚鈫SEšq“f‚Ģ”­Œ»•p“x‚ĶCŽg—p‚·‚éR‚Ŗ‚ń–ņ‚ĢĆ“f«‚É‘å‚«‚­‰e‹æ‚³‚źC‚»‚Ģ’ö“x‚š’č‹`‚·‚é•Ŗ—Ž‚ĶlˆÄ‚³‚ź‚Ä‚¢‚é‚ą‚Ģ‚ĢCŠm—§‚³‚ź‚½‚ą‚Ģ‚Å‚Ķ‚Č‚¢B–{ƒKƒCƒhƒ‰ƒCƒ“‚Å‚ĶCŠCŠO‚ĢƒKƒCƒhƒ‰ƒCƒ“‚Ę“Æ—lC§“f–ņ‚Ģ—\–h“I“Š—^‚Č‚µ‚ÅŠeŽķR‚Ŗ‚ń–ņ“Š—^Œć24 ŽžŠŌˆČ“ą‚É”­Œ»‚·‚鈫SEšq“fi‹}«‚Ģˆ«SEšq“fj‚ĢŠ„‡i“j‚ɏ]‚Į‚Ä’č‹`‚µC4 ‚Ā‚É•Ŗ—Ž‚µ‚½B

  • ‚“xiĆ“f«jƒŠƒXƒNihigh emetic riskj: 90“‚š’“‚¦‚銳ŽŅ‚É”­Œ»‚·‚é
  • ’†“™“xiĆ“f«jƒŠƒXƒNimoderate emetic riskj: 30`90“‚ĢŠ³ŽŅ‚É”­Œ»‚·‚é
  • Œy“xiĆ“f«jƒŠƒXƒNilow emetic riskj: 10`30“‚ĢŠ³ŽŅ‚É”­Œ»‚·‚é
  • Å¬“xiĆ“f«jƒŠƒXƒNiminimal emetic riskj: ”­Œ»‚µ‚Ä‚ą10“–¢–ž‚Å‚ ‚é

② ‚»‚Ģ‘¼‚ĢĆ“fƒŠƒXƒN

ć‹L‚ĢˆöŽq‚Ģ‚Ł‚©CŽ”—ĆŠÖ˜AˆöŽq‚Ę‚µ‚Ä‚Ķ•śŽĖüĘŽĖiØCQ10j‚āƒIƒsƒIƒCƒhiØCQ18j‚Ŗ‚ ‚čCŠ³ŽŅŠÖ˜AˆöŽq‚ąŽw“E‚³‚ź‚Ä‚¢‚é‚ŖiØCQ11jC‘Īˆ•ū–@‚Ķ”ŒćŒ¤‹†‚ši‚ß‚Ä‚¢‚­•K—v‚Ŗ‚ ‚éB

i2j’ŽĖR‚Ŗ‚ń–ņ‚É‚Ø‚Æ‚éĆ“f«ƒŠƒXƒN•]‰æ

R‚Ŗ‚ń–ņ‚ĢŽķ—ŽC“Š—^—ŹC•¹—pR‚Ŗ‚ń–ņ‚É‚ę‚čĆ“f«‚ĶˆŁ‚Č‚Į‚Ä‚Ø‚čC–{ƒKƒCƒhƒ‰ƒCƒ“‚Å‚Ķ•\2i’ŽĖR‚Ŗ‚ń–ņ‚ĢĆ“f«ƒŠƒXƒN•Ŗ—Žj‚ÉŽ¦‚·‚ꂤ‚ČƒŠƒXƒN•Ŗ—Ž‚šs‚Į‚½BŽQl‚É‚µ‚½ŠCŠO‚ĢƒKƒCƒhƒ‰ƒCƒ“‚ĢƒRƒ“ƒZƒ“ƒTƒXƒŒƒxƒ‹‚Ķ‚‚­C‚ķ‚Ŗ‘‚ĢƒCƒ“ƒ^ƒrƒ…[ƒtƒH[ƒ€‚ĢŒ‹‰Ź‚Č‚Ē‚Ęˆź’v‚š‚Ż‚Č‚¢“ą—e‚ą‚ ‚é‚Ŗ2jC‘“ą‚ĢƒGƒrƒfƒ“ƒX‚šdŽ‹‚µ‚½ģ¬ˆĻˆõ‰ļ‚ĢƒRƒ“ƒZƒ“ƒTƒX‚Ģ‚ą‚Ę‚ÅŒˆ’肵‚½B

‚Ł‚Ę‚ń‚Ē‚Ģ–ņÜ‚Ķ’PÜ‚Å‚Ģ•Ŗ—Ž‚Ę‚Č‚Į‚Ä‚¢‚é‚ŖCƒAƒ“ƒgƒ‰ƒTƒCƒNƒŠƒ“ŒnR‚Ŗ‚ń–ņ‚ĘƒVƒNƒƒzƒXƒtƒ@ƒ~ƒh‚Ķ2 Ü•¹—p—Ć–@‚Ģź‡‚ÉHEC ‚ÉŠÜ‚ß‚½B‘½‚­‚Ģ‚Ŗ‚ń–ņ•Ø—Ć–@‚É‘½Ü•¹—p—Ć–@‚Ŗ—p‚¢‚ē‚ź‚Ä‚Ø‚čCŒ“‘„CÅ‘å‚ĢĆ“f«ƒŠƒXƒN‚É‘Ī‚·‚鐧“f—Ć–@‚Ŗ„§‚³‚ź‚é‚ŖC‹ļ‘Ģ“I‚Č‘Ī‰ž‚Ķ‘ę2 Ķ‚Ģ‘ŸŠķ‚Ŗ‚ń•Ź‚ĢƒŒƒWƒƒ“ˆź——‚šŽQl‚É‚³‚ź‚½‚¢B

‚ķ‚Ŗ‘‚Å‚Ģ‚ŻŽg—p‰Ā”\‚Č–ņÜ‚ĶC³”F\æŽž‚Ģƒf[ƒ^CŽs”ĢŒć‚Ģ‘ć•\“I‚Č—Õ°ŽŽŒ±C»‘¢”Ģ”„Œć Žg—p¬Ń’²ø‚Ģƒf[ƒ^“™‚š—p‚¢‚Ä•Ŗ—Ž‚µ‚Ä‚¢‚é‚ŖC“–Žž‚Ģ•]‰æ•ū–@‚Ŗ‹ß”N‚ĘˆŁ‚Č‚Į‚Ä‚¢‚邱‚Ę‚ą ‚ ‚Į‚Ä•sŠmŽĄ«‚ŖŠÜ‚Ü‚ź‚Ä‚¢‚邱‚Ę‚É—ÆˆÓ‚·‚éB

•\2@’ŽĖR‚Ŗ‚ń–ņ‚ĢĆ“f«ƒŠƒXƒN•Ŗ—Ž
•Ŗ—Ž –ņÜCƒŒƒWƒƒ“
‚“xiĆ“f«jƒŠƒXƒN
high emetic risk
iĆ“f•p“x@„90“j
  • AC —Ć–@: ƒhƒLƒ\ƒ‹ƒrƒVƒ“{ƒVƒNƒƒzƒXƒtƒ@ƒ~ƒh
  • EC —Ć–@: ƒGƒsƒ‹ƒrƒVƒ“{ƒVƒNƒƒzƒXƒtƒ@ƒ~ƒh
  • ƒCƒzƒXƒtƒ@ƒ~ƒhi† 2 g/m2/‰ńj
  • ƒGƒsƒ‹ƒrƒVƒ“i† 90 mg/m2j
  • ƒVƒNƒƒzƒXƒtƒ@ƒ~ƒhi†1,500 mg/m2j
  • ƒVƒXƒvƒ‰ƒ`ƒ“
  • ƒXƒgƒŒƒvƒgƒ]ƒVƒ“
  • ƒ_ƒJƒ‹ƒoƒWƒ“
  • ƒhƒLƒ\ƒ‹ƒrƒVƒ“i† 60 mg/m2j
  • carmustinei„250 mg/m2j
  • mechlorethamine
’†“™“xiĆ“f«jƒŠƒXƒN
moderate emetic risk
iĆ“f•p“x@30`90“j
ƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“iHEC ‚ɏ€‚¶‚½ˆµ‚¢j
”ńƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“
  • ƒAƒNƒ`ƒmƒ}ƒCƒVƒ“D
  • ƒAƒUƒVƒ`ƒWƒ“
  • ƒAƒ€ƒ‹ƒrƒVƒ“¦6j
  • ƒCƒ_ƒ‹ƒrƒVƒ“
  • ƒCƒmƒcƒYƒ}ƒu ƒIƒ]ƒKƒ}ƒCƒVƒ“
  • ƒCƒzƒXƒtƒ@ƒ~ƒhiƒ2 g/m2/‰ńj
  • ƒCƒŠƒmƒeƒJƒ“
  • ƒCƒ“ƒ^[ƒtƒFƒƒ“-ƒæi†10 million IU/m2j
  • ƒCƒ“ƒ^[ƒƒCƒLƒ“-2i„12`15 million IU/m2j
  • ƒGƒmƒVƒ^ƒrƒ“¦7j
  • ƒGƒsƒ‹ƒrƒVƒ“iƒ90 mg/m2j
  • ƒIƒLƒTƒŠƒvƒ‰ƒ`ƒ“
  • ƒNƒƒtƒ@ƒ‰ƒrƒ“
  • ŽOŽ_‰»ƒq‘f
  • ƒVƒNƒƒzƒXƒtƒ@ƒ~ƒhiƒ1,500 mg/m2j
  • ƒVƒ^ƒ‰ƒrƒ“i„200 mg/m2j
  • ƒ_ƒEƒmƒ‹ƒrƒVƒ“
  • ƒeƒ‚ƒ]ƒƒ~ƒh
  • ƒhƒLƒ\ƒ‹ƒrƒVƒ“iƒ60 mg/m2j
  • ƒgƒ‰ƒxƒNƒeƒWƒ“
  • ƒlƒ_ƒvƒ‰ƒ`ƒ“¦8j
  • ƒsƒ‰ƒ‹ƒrƒVƒ“¦9j
  • ƒuƒXƒ‹ƒtƒ@ƒ“
  • ƒxƒ“ƒ_ƒ€ƒXƒ`ƒ“
  • ƒ~ƒŠƒvƒ‰ƒ`ƒ“10j
  • ƒƒgƒgƒŒƒLƒT[ƒgi†250 mg/m2j
  • ƒƒ‹ƒtƒ@ƒ‰ƒ“
  • aldesleukini> 12-15 million IU/m2j
  • amifostinei„300 mg/m2j
  • carmustinei…250 mg/m2j
  • dinutuximab
Œy“xiĆ“f«jƒŠƒXƒN
low emetic risk
iĆ“f•p“x@10`30“j
  • ƒAƒeƒ]ƒŠƒYƒ}ƒu
  • ƒCƒ“ƒ^[ƒtƒFƒƒ“-ƒæi5`10 million IU/m2j
  • ƒCƒ“ƒ^[ƒƒCƒLƒ“-2i…12 million IU/m2j
  • ƒGƒgƒ|ƒVƒh
  • ƒGƒŠƒuƒŠƒ“
  • ƒGƒƒcƒYƒ}ƒu
  • ƒJƒoƒWƒ^ƒLƒZƒ‹
  • ƒJƒ‹ƒtƒBƒ‹ƒ]ƒ~ƒu
  • ƒQƒ€ƒVƒ^ƒrƒ“
  • ƒVƒ^ƒ‰ƒrƒ“i100`200 mg/m2j
  • ƒ_ƒ‰ƒcƒ€ƒ}ƒu
  • ƒgƒ‰ƒXƒcƒYƒ}ƒu@ƒGƒ€ƒ^ƒ“ƒVƒ“
  • ƒhƒLƒ\ƒ‹ƒrƒVƒ“@ƒŠƒ|ƒ\[ƒ€
  • ƒhƒZƒ^ƒLƒZƒ‹
  • ƒjƒ€ƒXƒ`ƒ“¦11j
  • ƒmƒMƒeƒJƒ“
  • ƒpƒNƒŠƒ^ƒLƒZƒ‹
  • ƒpƒNƒŠƒ^ƒLƒZƒ‹@ƒAƒ‹ƒuƒ~ƒ“Œœ‘÷Œ^
  • ƒtƒ‹ƒIƒƒEƒ‰ƒVƒ‹
  • ƒuƒŒƒ“ƒcƒLƒVƒ}ƒu
  • ƒyƒƒgƒŒƒLƒZƒh
  • ƒyƒ“ƒgƒXƒ^ƒ`ƒ“
  • ƒ}ƒCƒgƒ}ƒCƒVƒ“C
  • ƒ~ƒgƒLƒTƒ“ƒgƒƒ“
  • ƒƒgƒgƒŒƒLƒT[ƒgi50`250 mg/m2–¢–žj
  • ƒ‰ƒjƒ€ƒXƒ`ƒ“¦12j
  • ƒƒ~ƒfƒvƒVƒ“
  • aldesleukini… 12 million IU/m2j
  • amifostinei…300 mg/m2j
  • belinostat
  • blinatumomab
  • floxuridine
  • irinotecan (lipospomal)
  • ixabepilone
  • necitumumab
  • omacetaxine
  • talimogene laherparepvec
Å¬“xiĆ“f«jƒŠƒXƒN
minimal emetic risk
iĆ“f•p“x@ƒ10“j
  • L-ƒAƒXƒpƒ‰ƒMƒi[ƒ[
  • ƒAƒxƒ‹ƒ}ƒu
  • ƒAƒtƒŠƒxƒ‹ƒZƒvƒg ƒx[ƒ^
  • ƒAƒŒƒ€ƒcƒYƒ}ƒu
  • ƒCƒsƒŠƒ€ƒ}ƒu
  • ƒCƒ“ƒ^[ƒtƒFƒƒ“-ƒæi…5 million IU/m2j
  • ƒIƒtƒ@ƒcƒ€ƒ}ƒu
  • ƒNƒ‰ƒhƒŠƒrƒ“
  • ƒQƒ€ƒcƒYƒ}ƒuƒIƒ]ƒKƒ}ƒCƒVƒ“*
  • ƒVƒ^ƒ‰ƒrƒ“iƒ100 mg/m2j
  • ƒZƒcƒLƒVƒ}ƒu
  • ƒeƒ€ƒVƒƒŠƒ€ƒX
  • ƒgƒ‰ƒXƒcƒYƒ}ƒu
  • ƒjƒ{ƒ‹ƒ}ƒu
  • ƒlƒ‰ƒ‰ƒrƒ“
  • ƒpƒjƒcƒ€ƒ}ƒu
  • ƒrƒmƒŒƒ‹ƒrƒ“
  • ƒrƒ“ƒNƒŠƒXƒ`ƒ“
  • ƒrƒ“ƒfƒVƒ“¦13j
  • ƒrƒ“ƒuƒ‰ƒXƒ`ƒ“
  • ƒvƒ‰ƒ‰ƒgƒŒƒLƒT[ƒg
  • ƒtƒ‹ƒ_ƒ‰ƒrƒ“
  • ƒuƒŒƒIƒ}ƒCƒVƒ“
  • ƒxƒoƒVƒYƒ}ƒu
  • ƒyƒOƒCƒ“ƒ^[ƒtƒFƒƒ“
  • ƒyƒvƒƒ}ƒCƒVƒ“¦14j
  • ƒyƒ‹ƒcƒYƒ}ƒu
  • ƒyƒ“ƒuƒƒŠƒYƒ}ƒu
  • ƒ{ƒ‹ƒeƒ]ƒ~ƒu
  • ƒƒgƒgƒŒƒLƒT[ƒgi…50 mg/m2j
  • ƒ‰ƒ€ƒVƒ‹ƒ}ƒu
  • ƒŠƒcƒLƒVƒ}ƒu
  • decitabine
  • denileukin diftitox
  • obinutuzumab
  • pegaspargase
  • pixantrone
  • siltuximab
  • valrubicin
  • vincristineiliposomalj

’1: ‰pŒź•\‹L‚Ķ–{–M–¢³”FB
’ 2: u ¦v‚ĶŠCŠO‚ĢƒKƒCƒhƒ‰ƒCƒ“‚É‚Ķ‹LŚ‚Ŗ‚Č‚¢‚ŖC‚ķ‚Ŗ‘‚Å‚ĶŽg—p‰Ā”\‚Č–ņÜB
’3: ‰ŗü•t‚«‚Ģ–ņÜ‚Ķ30 ”NˆČć‘O‚ÉŠJ”­‚³‚ź‚½–ņÜiƒAƒ€ƒ‹ƒrƒVƒ“Cƒlƒ_ƒvƒ‰ƒ`ƒ“Cƒsƒ‰ƒ‹ƒrƒVƒ“‚šœ‚­jB

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moderate emetic risk
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low emetic risk
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  • ƒoƒ“ƒfƒ^ƒjƒu
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  • ƒ|ƒiƒ`ƒjƒu
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minimal emetic risk
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  • 6-thioguanine
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‚±‚Ģ7“śŠŌ‚ŁC“f‚«‹C‚Ķˆź”Ō‚Š‚Ē‚¢Žž‚Å‚Ē‚Ģ’ö“x‚Å‚µ‚½‚©H

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‚±‚Ģ7“śŠŌ‚ŁCšq“f‚Ķˆź”Ō‚Š‚Ē‚¢Žž‚Å‚Ē‚Ģ’ö“x‚Å‚µ‚½‚©H

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+ ŽQl‚É‚µ‚½“ńŽŸŽ‘—æ
  1. NCCN Clinical Practice Guidelines in Oncology-Antiemesis-ver. 2, 2017
  2. MASCC/ESMO Antiemetic Guidelines 2016
  3. Hesketh PJ, Kris MG, Basch E, Basch E, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017; 35: 3240-61.
ŽQl•¶Œ£

1j ²”ŒrŗD§“f–ņ“K³Žg—pƒKƒCƒhƒ‰ƒCƒ“‚ÉŠÖ‚·‚éƒAƒ“ƒP[ƒg’²øDŠą‚ʉ»—ƁD2015; 42: 305-11D

2j “n•”’q‹MC”¼“c’qŽqC‰Į“”—T‹vD“ś–{‘“ą‚Ģ—Տ°ŽŽŒ±‚ÉŠī‚Ć‚­R‚Ŗ‚ńÜ‚ĢĆ“f«ƒŠƒXƒN•Ŗ—ŽDŠą‚ʉ»—ƁD2015; 42: 335-41D

3j —LŠQŽ–Ū‹¤’Ź—pŒź‹K€v4.0“ś–{Œź–óJCOG”Å(CTCAE v4.0 - JCOGj
iaccessed January 18, 2018j

4j Tamura K, Aiba K, Saeki T, et al. Testing the effectiveness of antiemetic guidelines: results of a prospective registry by the CINV Study Group of Japan. Int J Clin Oncol. 2015; 20: 855-65.

5j PRO-CTCAE™ “ś–{Œź”Å.
https: //healthcaredelivery.cancer.gov/pro-ctcae/pro-ctcae_japanese.pdfiaccessed January 18, 2018j

6j Yana T, Negoro S, Takada M, et al. Phase‡U study of amrubicin in previously untreated patients with extensive-disease small cell lung cancer: West Japan Thoracic Oncology GroupiWJTOGjstudy. Invest New Drugs. 2007; 25: 253-8.

7j Kimura K, Yamada K, Uzuka Y, et al. Phase‡T study of N4-behenoyl-1-1-beta-d-arabinofuranosylcytosine and its phase‡U study in adult acute leukemia. Current chemotherapy and immunotherapy. Proceedings. 12th International Congress of Chemotherapy, pp 1306-8, 1982.

8j ‘¾“c˜a•vDƒlƒ_ƒvƒ‰ƒ`ƒ“iNedaplatinj‚É‚Ā‚¢‚āDŠą‚ʉ»—ƁD1996; 23: 79-87D

9j ’Ė‰z–ĪDPirarubiciniTHP-Adriamycinj‚É‚Ā‚¢‚āDŠą‚ʉ»—ƁD1998; 15: 2819-27D

10j Fujiyama S, Shibata J, Maeda S, et al. Phase I clinical study of a novel lipophilic platinum complexiSM-11355jin patients with hepatocellular carcinoma refractory to cisplatin/lipiodol. Br J Cancer. 2003; 89: 1614-9.

11j Ä“”’B—YDNitrosourea ŒnV‹KRŠąÜACNUo1-i4-Amino-2-methyl-5-pyrimidanyljmethyl-2-i2-chloroethylj-3-nitrosourea hydrochloridep‚ĢPhase‡T‚Ø‚ę‚ŃPhase‡UStudyDŠą‚ʉ»—ƁD1977; 4: 105-18D

12j ³‰Ŗ“OC‘¼D‘¢ŒŒŠķŽīį‡«Ž¾Š³‚É‚Ø‚Æ‚éMCNU ‚Ģ—Տ°‘ęⅡ ‘ŠŽŽŒ±DChemotherapyD1985; 33: 271-8D

13j –Ų‘ŗāU‘ć“ńD‹¤“ÆŒ¤‹†‚É‚ę‚éVidesine sulfate ‚ĢŒÅŒ`Žīį‡‚É‘Ī‚·‚éPhase‡UStudyDŠą‚ʉ»—ƁD1983; 10: 2036-42D

14j Œ¢ŽRŖ•vDƒyƒvƒŒƒIƒ}ƒCƒVƒ“DŠą‚ʉ»—ƁD1980; 7: 1498-504D

15j Schlumberger M, Tahara M, Wirth LJ, et al. Lenvatinib versus placebo in radioiode-refractory thyroid cancer. N Engl J Med. 2015 ; 372: 621-30.

16j Seto T, Kiura K, Nishio M, et al. CH5424802iRO5424802jfor patients with LK-rearranged advanced non-small-cell lung canceriAF-001JP studyj: a single-arm, open-label, phase 1-2 study. Lancet Oncol. 2013; 14: 590-8.

17j Vidula N, Rugo HS. Cycline-dependent linase 4/6 inhibitors for the treatment of breast cancer: a review of preclinical and clinical data. Clin Breast Cancer. 2016; 16: 8-17.

18) Goss G, Tsai CM, Shepherd FA, et al. Osimertinb for pretreated EGFR Thr790Met-positive advanced non-small-cell lung cancer (AURA2): a multicenter, open-label, single-arm, phase 2 study. Lancet Oncol. 2016 ; 17 : 1643-52.

19) Kantarjian HM, Shah NP, Cortes JE, et al. Dasatinib in newly diagnosed chronic-phase chronic myeloid leukemia: 2-year follow-up from a randomized phase 3 trial (DASISION). Blood. 2012; 119: 1123-29

20) Flaherty KT, Robert C, Hersy P, et al. Improved survival with MEK inhibitor in BRAF-mutated melanoma. N Engl J Med. 2012 ; 367: 107-14.

21) Dummer R, Duvic M, Scarisbrick J, et al. Final results of multicenter phase II Study of the purine nucleoside phosphorylase (PNP) inhibitor forodesine in patients with advanced cutaneous t-cell lymphomas (CTCL) (Mydosis fungoides and Sé zary syndrome). Ann of Oncol . 2014 ; 1807-12.


Clinical QuestionE„§ˆź——‚Ö


CQ1
ŒoŒūR‚Ŗ‚ń–ņ‚É‚ę‚鈫SEšq“f‚š‚Ē‚Ģ‚ꂤ‚ÉŽ”—Ć‚·‚é‚©

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C1 —LŒų«‚šŽ¦‚µ‚½—Տ°ŽŽŒ±‚ĢƒvƒƒgƒR[ƒ‹‚šŽQĘ‚µCu‰½‚ē‚©‚ĢŽxŽ—Ć–@vØu‹x–ņvØuŒø—Źv‚ĢŒ“‘„‚šŽē‚čCGrade 3 ˆČć‚Ģˆ«SEšq“f‚š”­Œ»‚³‚¹‚ø‚É“ą•žŒp‘±‚š}‚éB
+ ”wŒiE–Ś“I

‹ß”NCŒoŒū“Š—^‚ĢR‚Ŗ‚ń–ņ‚Ŗ‘‚¦‚Ä‚«‚Ä‚Ø‚čCŽE×–E«R‚Ŗ‚ń–ņ‚¾‚Æ‚Å‚Č‚­C‘½”‚Ģ•ŖŽq•W“I–ņ‚ą—Տ°“±“ü‚³‚ź‚Ä‚¢‚éB

ˆČ‘O‚ę‚č‚ķ‚Ŗ‘‚Å‚ĶCŒoŒūR‚Ŗ‚ń–ņ‚Ģ‚¤‚æƒtƒb‰»ƒsƒŠƒ~ƒWƒ“–ņ‚ĢŽg—p•p“x‚Ŗ‚‚­C‘å’°‚Ŗ‚ń‚É‚Ø‚Æ‚éUFT/ƒƒCƒRƒ{ƒŠƒ“CƒJƒyƒVƒ^ƒrƒ“CˆŻ‚Ŗ‚ń‚É‚Ø‚Æ‚éS-1C”x‚Ŗ‚ń‚É‚Ø‚Æ‚éUFT ‚Ķ”äŠrŽŽŒ±‚É‚ę‚čpŒć•ā•–ņ•Ø—Ć–@‚Ģ—LŒų«‚ŖŽ¦‚³‚ź‚Ä‚¢‚éB‚Ü‚½CŲœ•s”\Ä”­ˆŻ‚Ŗ‚ń‚ā‘å’°‚Ŗ‚ń‚É‘Ī‚µ‚Ä‚ąCS-1 ‚āƒJƒyƒVƒ^ƒrƒ“CUFT/ƒƒCƒRƒ{ƒŠƒ“C‘å’°‚Ŗ‚ń‚É‚Ø‚Æ‚éTAS102iƒgƒŠƒtƒ‹ƒŠƒWƒ“Eƒ`ƒsƒ‰ƒVƒ‹‰–Ž_‰–j‚ĶCƒKƒCƒhƒ‰ƒCƒ“‚Ő„§‚³‚ź‚Ä‚¢‚鎔—Ć‚Ģˆź‚Ā‚Å‚ ‚éB‚±‚ź‚ē‚ĢŒoŒūR‚Ŗ‚ń–ņ‚Ķ’P‰ń‚Å‚ĢĆ“f«ƒŠƒXƒN‚Ķ­‚Č‚¢‚ŖC˜A“ś“ą•ž‚É‚ę‚éĮ‰»ŠķĒó‚Ŗ‚ ‚éB

•ŖŽq•W“I–ņ‚ĶCŒoŒū–ņ‚Ģ•ū‚Ŗˆ«SEšq“f‚Ŗ‘½‚¢ŒXŒü‚É‚ ‚čC’†‚Å‚ąƒNƒŠƒ]ƒ`ƒjƒuCƒZƒŠƒ`ƒjƒuCƒŒƒ“ƒoƒ`ƒjƒuCƒpƒmƒrƒmƒXƒ^ƒbƒg‚Ķ30“ˆČć‚ĢĆ“f«ƒŠƒXƒN‚Ŗ‚ ‚é‚Ę‚³‚ź‚Ä‚¢‚éiNCCNƒKƒCƒhƒ‰ƒCƒ“2017jB

‚±‚ź‚ēŒoŒūR‚Ŗ‚ń–ņ‚ĢŽ”—ĆŒų‰Ź‚š“¾‚邽‚ß‚É‚ĶC•ž—pƒAƒhƒqƒAƒ‰ƒ“ƒX‚š‘¹‚Č‚ķ‚Č‚¢‚ꂤˆ«SEšq“f‘Īō‚Ŗd—v‚Å‚ ‚éB

+ ‰šą

Œy“xƒŠƒXƒN‚ĢŒoŒūR‚Ŗ‚ń–ņ‚É‘Ī‚µ‚āCMASCC/ESMO ƒKƒCƒhƒ‰ƒCƒ“2016 ‚Å‚ĶC§“f–ņ3 Žķ—Ži5-HT3Žó—e‘ĢhR–ņCƒfƒLƒTƒƒ^ƒ]ƒ“Cƒhƒpƒ~ƒ“Žó—e‘ĢhR–ņj‚š’PÜ‚ÅŽg—p‚·‚邱‚Ę‚ŖŠ©‚ß‚ē‚ź‚Ä‚¢‚é‚ŖCÅ¬“xƒŠƒXƒN‚É‘Ī‚·‚鐧“f–ņ‚Ģ—\–h“IŽg—p‚Ķ„§‚³‚ź‚Ä‚¢‚Č‚¢Bˆź•ūCNCCN ƒKƒCƒhƒ‰ƒCƒ“2017 ‚Å‚ĶCŒy“xEÅ¬“xƒŠƒXƒN‚ĢŒoŒūR‚Ŗ‚ń–ņ‚šŠÜ‚߂āCˆ«SEšq“f‚Ŗ¶‚¶‚½Ū‚ɃƒgƒNƒƒvƒ‰ƒ~ƒhCƒvƒƒNƒƒ‹ƒyƒ‰ƒWƒ“C5-HT3Žó—e‘ĢhR–ņ‚Č‚Ē‚Ģ˜A“ś“Š—^i•K—v‚ɉž‚¶‚ăIƒ‰ƒ“ƒUƒsƒ“‚āƒƒ‰ƒ[ƒpƒ€‚š•¹—pj‚Ŗ„§‚³‚ź‚Ä‚¢‚éB‚µ‚©‚µCŒoŒūR‚Ŗ‚ń–ņ‚É‘Ī‚·‚鐧“f–ņ‚Ģ”äŠrŽŽŒ±‚Ŗ‚Č‚¢‚½‚߁C‚±‚ź‚ē‚Ģ„§‚³‚ź‚鐧“f—Ć–@‚ĢM—Š“x‚Ķ’į‚¢B‚½‚¾‚µC‚±‚ź‚ē‚ĢŒoŒūR‚Ŗ‚ń–ņ‚Ģ—LŒų«‚ĢƒGƒrƒfƒ“ƒX‚šŽ¦‚µ‚½”äŠrŽŽŒ±‚ĢƒvƒƒgƒR[ƒ‹‚š‚Ż‚é‚ʁCGrade 2 ‚Ģˆ«SEšq“f‚Ŗ”­Œ»‚µ‚½ź‡‚É‚Ķ‚؂؂Ž‚ĖŽxŽ—Ć–@‚šs‚¤‚©‚Ü‚½‚Ķ‹x–ņ‚µCŽxŽ—Ć–@‚É‚ę‚Į‚ăRƒ“ƒgƒ[ƒ‹‚Å‚«‚Č‚¢ź‡‚É‚ĶC“Š—^—Ź‚šˆź’iŠKŒø—Ź‚·‚éC‚³‚ē‚ÉGrade 3 ‚Ģˆ«SEšq“f‚Ŗ”­Œ»‚µ‚½ź‡‚ĶC“Š—^—Ź‚šˆź’iŠKŒø—Ź‚·‚邱‚Ę‚Ŗˆź”Ź“I‚Å‚ ‚éB‚µ‚½‚Ŗ‚Į‚āC‚Ŗ‚ń–ņ•Ø—Ć–@‚ĢƒGƒrƒfƒ“ƒX‚šŽ¦‚µ‚½—Տ°ŽŽŒ±‚ĢƒvƒƒgƒR[ƒ‹‚šŽQl‚ɁC“śķ—Տ°‚ÅŽg—p‚³‚ź‚Ä‚¢‚é–ņÜ‚šŽg—p‚·‚é‚Ł‚©CHŽ–‚ĢH•vCƒJƒEƒ“ƒZƒŠƒ“ƒO‚Č‚Ē‚ĢŽxŽ—Ć–@‚šŽĄŽ{‚µCƒRƒ“ƒgƒ[ƒ‹•s—Ē‚ĢŪ‚Ķ‹x–ņ‚µCR‚Ŗ‚ń–ņ‚šˆź’iŠKŒø—Ź‚µ‚čĊJ‚·‚é‚Ę‚¢‚¤Œ“‘„‚šŽē‚čCGrade 3 ˆČć‚Ģˆ«SEšq“f‚š”­Œ»‚³‚¹‚øCGrade 2‚Ģˆ«SEšq“f‚ŖŒp‘±‚µ‚Č‚¢‚ꂤ‚É“ą•ž‚šŒp‘±‚·‚邱‚Ę‚Ŗ‹‚ß‚ē‚ź‚éB

‚Ü‚½C‚“xE’†“™“xƒŠƒXƒN‚ĢŒoŒūR‚Ŗ‚ń–ņ‚É‘Ī‚µ‚āCMASCC/ESMO ƒKƒCƒhƒ‰ƒCƒ“2016 ‚Å‚ĶC5-HT3Žó—e‘ĢhR–ņC•›t”ēŽæƒXƒeƒƒCƒh‚Ģ2 Ü•¹—p‚Ŗ„§‚³‚ź‚Ä‚¢‚éBNCCN ƒKƒCƒhƒ‰ƒCƒ“2017 ‚Å‚ĶC5-HT3Žó—e‘ĢhR–ņ‚ĢŒoŒū˜A“ś“Š—^‚Ŗ„§‚³‚ź‚Ä‚¢‚é‚ŖCƒVƒNƒƒzƒXƒtƒ@ƒ~ƒhCƒGƒgƒ|ƒVƒhCƒeƒ‚ƒ]ƒƒ~ƒh‚Å‚ĶC“śķ—Տ°‚É‚Ø‚¢‚ÄŽ”—Ć–Ś“I‚ā•śŽĖüŽ”—Ć•¹—p‚Ģ‚½‚ß‚É•›t”ēŽæƒXƒeƒƒCƒh‚Ŗ•¹—p‚³‚ź‚Ä‚¢‚邱‚Ę‚Ŗ‘½‚¢B

+ ŽQl‚É‚µ‚½“ńŽŸŽ‘—æ
  1. NCCN Clinical Practice Guidelines in Oncology-Antiemesis-ver. 2, 2017
  2. MASCC/ESMO Antiemetic Guidelines 2016

Clinical QuestionE„§ˆź——‚Ö


CQ2
‚Ŗ‚ń–ņ•Ø—Ć–@Œć‚Ģ‹}«‚Ģˆ«SEšq“f‚š‚Ē‚Ģ‚ꂤ‚É—\–h‚·‚é‚©

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A ‚“xƒŠƒXƒN‚ĢR‚Ŗ‚ń–ņ‚É‚ę‚é‹}«‚Ģˆ«SEšq“f‚É‘Ī‚µ‚Ä‚ĶCƒAƒvƒŒƒsƒ^ƒ“ƒgi‚ą‚µ‚­‚ĶƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒgj‚Ę5-HT3Žó—e‘ĢhR–ņ‚Ø‚ę‚ŃƒfƒLƒTƒƒ^ƒ]ƒ“‚š•¹—p‚·‚éB
A ’†“™“xƒŠƒXƒN‚ĢR‚Ŗ‚ń–ņ‚É‚ę‚é‹}«‚Ģˆ«SEšq“f‚É‘Ī‚µ‚Ä‚ĶC5-HT3Žó—e‘ĢhR–ņ‚ĘƒfƒLƒTƒƒ^ƒ]ƒ“‚š•¹—p‚µC“Į’č‚ĢR‚Ŗ‚ń–ņ‚šŽg—p‚·‚鏼‡‚ĶC‚»‚ź‚¼‚ź‚ĢŠ³ŽŅ‚Ģó‹µ‚ɉž‚¶‚ăAƒvƒŒƒsƒ^ƒ“ƒg‚š’Ē‰ĮE•¹—p‚·‚éB
B ƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“iAUC†4j‚É‘Ī‚µ‚Ä‚Ķ‚“xƒŠƒXƒN‚ĢR‚Ŗ‚ń–ņ‚ɏ€‚¶‚āCƒAƒvƒŒƒsƒ^ƒ“ƒgi‚ą‚µ‚­‚ĶƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒgj‚Ę5-HT3 Žó—e‘ĢhR–ņ‚Ø‚ę‚ŃƒfƒLƒTƒƒ^ƒ]ƒ“‚š•¹—p‚·‚éB
+ ”wŒiE–Ś“I

R‚Ŗ‚ń–ņ‚ĢĆ“f«ƒŠƒXƒN‚ĶC‚“xC’†“™“xCŒy“xCÅ¬“x‚Ģ4 ’iŠK‚É•Ŗ—Ž‚³‚ź‚éB—ĒD‚ČŽ”—ĆƒAƒhƒqƒAƒ‰ƒ“ƒX‚š“¾‚āC‚Ŗ‚ńŽ”—Ć‚š‰~ŠŠ‚ɐi‚߂邽‚ß‚É‚ąCĆ“f«ƒŠƒXƒN‚Ģ“K³‚Č•]‰æ‚ĘŒĀX‚ĢĒ—į‚ɉž‚¶‚½—\–h“I‘Īˆ‚šs‚¤•K—v‚Ŗ‚ ‚éB

+ ‰šą

R‚Ŗ‚ń–ņ“Š—^ŒćC24 ŽžŠŌˆČ“ą‚ɏoŒ»‚·‚é‹}«šq“f‚ĶCR‚Ŗ‚ń–ņ‚ĢŽ”—ĆƒAƒhƒqƒAƒ‰ƒ“ƒX‚š–W‚°‚éÅ‚ą‘å‚«‚Č—vˆö‚Ģˆź‚Ā‚Å‚ ‚čC‚»‚Ģ—\–h§“fŒų‰Ź‚Ģ¬”Ū‚Ķ’x”­«šq“f‚ĢŽ”—ĆŒų‰Ź‚É‚ą‰e‹æ‚š‹y‚Ś‚·1jB‚µ‚½‚Ŗ‚Į‚āC“Į‚ÉĆ“f«ƒŠƒXƒN‚Ŗ‚“x‚Ø‚ę‚Ń’†“™“x‚ĢR‚Ŗ‚ń–ņ“Š—^‚ɍŪ‚µ‚Ä‚ĶC‹}«šq“f‚š–¢‘R‚É–h‚¬C‚³‚ē‚É’x”­«šq“f‚ĢŽ”—Ć”½‰ž«‚š—ĒD‚É•Ū‚Ā‚½‚ß‚É‚ąCĻ‹É“I‚Ȑ§“f–ņ‚Ģ“Š—^‚šs‚¤•K—v‚Ŗ‚ ‚éBˆČ‰ŗ‚É‹}«šq“f‚Ģ—\–h‚š–Ś“I‚Ę‚µ‚āCR‚Ŗ‚ń–ņ“Š—^‘O‚ɍs‚¤‚ׂ«‘Īˆ‚šĆ“f«ƒŠƒXƒN•Ź‚ÉŠTą‚·‚éB

1j‚“xƒŠƒXƒN

NK1Žó—e‘ĢhR–ņ‚Å‚ ‚éƒAƒvƒŒƒsƒ^ƒ“ƒg125 mg ŒoŒū“Š—^2j‚ą‚µ‚­‚ĶƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒg150 mg Ć–¬“ą“Š—^‚Ę5-HT3Žó—e‘ĢhR–ņ‚Ø‚ę‚ŃƒfƒLƒTƒƒ^ƒ]ƒ“9.9 mg Ć’i12 mg ŒoŒūj‚Ģ3 Ü•¹—p‚Ŗ„§‚³‚ź‚éB‘ę1 ¢‘ć‚Ģ5-HT3Žó—e‘ĢhR–ņ‚ĘƒfƒLƒTƒƒ^ƒ]ƒ“‚Ģ2 Ü•¹—p‚É”ä‚ׁCƒAƒvƒŒƒsƒ^ƒ“ƒg‚š‰Į‚¦‚½3 Ü‚š•¹—p‚·‚邱‚Ę‚Å§“fģ—p‚Ģ’˜‚µ‚¢‰ü‘P‚ŖŽ¦‚³‚ź‚Ä‚¢‚é3j`5jB‘ę1 ¢‘ć‚Ģ5-HT3Žó—e‘ĢhR–ņiØCQ4 ŽQĘj‚ĶC’PÜŠŌ‚Ģ’¼Ś”äŠr‚Ø‚ę‚ŃƒfƒLƒTƒƒ^ƒ]ƒ“•¹—p‰ŗ‚Å‚Ģ”äŠr‚É‚Ø‚¢‚āC–ņÜŠŌ‚Ü‚½‚»‚Ģ“Š—^Œo˜H‚É‚ę‚Į‚ÄŒų‰Ź‚É‘å‚«‚ȍ·‚Ķ‚Č‚­6j`8jC—p—Ź‚ā“Š—^‰ń”‚Ģ‰e‹æ‚šŽó‚Æ‚Č‚¢‚±‚Ę‚©‚ē9j`12jCR‚Ŗ‚ń–ņ“Š—^ŠJŽn‘O‚É•K—v—Ź‚š’P‰ń“Š—^‚Ę‚·‚éB‘ę2 ¢‘ć5-HT3Žó—e‘ĢhR–ņ‚ĢƒpƒƒmƒZƒgƒƒ“‚ĶC’PÜŠŌ‚Ģ’¼Ś”äŠr‚Ø‚ę‚ŃƒfƒLƒTƒƒ^ƒ]ƒ“•¹—p‰ŗ‚Å‚Ģ”äŠr‚É‚Ø‚¢‚āC‹}«šq“f‚Ģ—\–hŒų‰Ź‚Ķ‘¼–ņÜ‚Ę“Æ“™‚Å‚ ‚é‚ŖC’x”­«šq“f‚Ģ—\–h‚É‚Ø‚¢‚Ä—D‚ź‚Ä‚¢‚é13j14jiØCQ3 ŽQĘjBƒfƒLƒTƒƒ^ƒ]ƒ“‚Ģ—p—ŹiØCQ5 ŽQĘj‚É‚Ā‚¢‚Ä‚ĶC‘ę1 ¢‘ć‚Ģ5-HT3Žó—e‘ĢhR–ņ‚Ę‚Ģ2 Ü•¹—p‚Å‚Ķ13.2`16.5 mg ‚šĆ’i16`20 mg ‚šŒoŒūj‚Ę‚³‚ź‚Ä‚«‚½‚ŖCƒAƒvƒŒƒsƒ^ƒ“ƒg‚Ę‚Ģ•¹—p‚Å‚ĶCƒAƒvƒŒƒsƒ^ƒ“ƒg‚ŖCYP3A4 ‚š‘jŠQ‚·‚邱‚Ę‚É‚ę‚čƒfƒLƒTƒƒ^ƒ]ƒ“‚Ģ”Z“x-ŽžŠŌ‹Čü‰ŗ–ŹĻiarea under the concentration-time curve; AUCj‚Ŗ‘‰Į‚·‚邽‚߁C3 Ü•¹—p‚Å‚Ķ9.9 mg Ć’i12 mg ŒoŒūj‚ÉŒø—Ź‚·‚éB‚½‚¾‚µC•›t”ēŽæƒXƒeƒƒCƒh‚ŖR‚Ŗ‚ń–ņ‚Ę‚µ‚Ä“Š—^‚³‚ź‚éCHOP —Ć–@‚Č‚Ē‚Å‚ĶƒŒƒWƒƒ““ą‚ĢƒXƒeƒƒCƒh‚ĶŒø—Ź‚µ‚Ä‚Ķ‚Č‚ē‚Č‚¢BƒAƒvƒŒƒsƒ^ƒ“ƒg‚Ģ“Š—^ŠśŠŌ‚Ķ3 “śŠŌ‚Ŗ„§‚³‚ź‚éBƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒg‚ĶƒAƒvƒŒƒsƒ^ƒ“ƒg‚Ģ…—n«‚šŒüć‚³‚¹‚½ƒŠƒ“Ž_‰»ƒvƒƒhƒ‰ƒbƒO‚Å‚ ‚čCĆ–¬“ą“Š—^Œć‚É‘Ģ“ą‚Ģ’EƒŠƒ“Ž_‰»y‘f‚É‚ę‚Į‚Ä‘¬‚ā‚©‚ÉŠˆ«–{‘Ģ‚Å‚ ‚éƒAƒvƒŒƒsƒ^ƒ“ƒg‚É•ĻŠ·‚³‚ź‚éBƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒg‚ĶƒIƒ“ƒ_ƒ“ƒZƒgƒƒ“CƒfƒLƒTƒƒ^ƒ]ƒ“‚Ę‚Ģ3 Ü•¹—p‚ŃAƒvƒŒƒsƒ^ƒ“ƒg‚Ę‚Ģ“Æ“™«‚ŖŽ¦‚³‚ź‚Ä‚Ø‚č15jC5-HT3Žó—e‘ĢhR–ņ‚ĘƒfƒLƒTƒƒ^ƒ]ƒ“•¹—p‰ŗ‚Å‚ĢR‚Ŗ‚ń–ņ“Š—^30 •Ŗ‘OC150 mg ‚Ģ’P‰ńŽg—p‚Ŗ„§‚³‚ź‚éB‚½‚¾‚µC•›ģ—p‚Ę‚µ‚Ä’ŽĖ•”ˆŹ’É/”­Ō/ŒŒš«Ć–¬‰Š‚Ģ•p“x‚Ŗ‚‚¢‚±‚Ę‚É—ÆˆÓ‚·‚ׂ«‚Å‚ ‚éB

NCCN ƒKƒCƒhƒ‰ƒCƒ“ 2015 ‚Å‚ĶCƒAƒvƒŒƒsƒ^ƒ“ƒg‚Ģ‘ć‚ķ‚č‚É‘½Žó—e‘Ģģ—pRø_•a–ņiMARTAj‚Å‚ ‚éƒIƒ‰ƒ“ƒUƒsƒ“‚šƒpƒƒmƒZƒgƒƒ“‚ĘƒfƒLƒTƒƒ^ƒ]ƒ“‚Ę3 Ü•¹—p‚Å—p‚¢‚éƒIƒvƒVƒ‡ƒ“‚ŖŽ¦‚³‚ź‚½B‚³‚ē‚É“Æ2017‚Å‚ĶCV‚½‚ɃAƒvƒŒƒsƒ^ƒ“ƒgi‚Ü‚½‚ĶƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒgjCƒpƒƒmƒZƒgƒƒ“CƒfƒLƒTƒƒ^ƒ]ƒ“‚Ģ3Ü•¹—p‚ɃIƒ‰ƒ“ƒUƒsƒ“‚š‰Į‚¦‚郌ƒWƒƒ“‚ą’ńŽ¦‚³‚ź‚½B‚±‚ź‚ē‚ĶCƒVƒXƒvƒ‰ƒ`ƒ“‚ĘAC—Ć–@‚šŠÜ‚Ž‚“xƒŠƒXƒNR‚Ŗ‚ń–ņ“Š—^‚ɍŪ‚µCƒIƒ‰ƒ“ƒUƒsƒ“‚ŖCƒpƒƒmƒZƒgƒƒ“‚ĘƒfƒLƒTƒƒ^ƒ]ƒ“•¹—p‰ŗ‚É‚Ø‚¢‚ăAƒvƒŒƒsƒ^ƒ“ƒg‚Ę“Æ“™‚Å‚ ‚邱‚Ę‚ŖŽ¦‚³‚ź‚½‘ę‡V‘Šƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±16j‚āCƒAƒvƒŒƒsƒ^ƒ“ƒgi‚Ü‚½‚ĶƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒgjCƒpƒƒmƒZƒgƒƒ“CƒfƒLƒTƒƒ^ƒ]ƒ“‚Ģ3Ü•¹—p‚ɃIƒ‰ƒ“ƒUƒsƒ“‚š‰Į‚¦‚é—L—p«‚ŖŽ¦‚³‚ź‚½‘ęIII‘Šƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±17j‚ĢŒ‹‰Ź‚šŽó‚Æ‚Ä‚¢‚éBASCO ƒKƒCƒhƒ‰ƒCƒ“2017 ‚Å‚ąƒIƒ‰ƒ“ƒUƒsƒ“‚š‰Į‚¦‚½4Ü•¹—p‚Ŗ„§—Ć–@‚Ę‚µ‚Ä’Ē‰Į‚³‚ź‚½BƒIƒ‰ƒ“ƒUƒsƒ“‚Ķ‚ķ‚Ŗ‘‚Å‚ą•””‚Ģ—Տ°ŽŽŒ±‚Ŗs‚ķ‚ź‚½18)-21)BƒIƒ‰ƒ“ƒUƒsƒ“‚ĶŒö’m\æ‚É‚ę‚č2017 ”N6 ŒŽ‚©‚ēC‘¼‚Ģ§“f–ņ‚Ę‚Ģ•¹—p‚É‚Ø‚¢‚Ьl‚Å‚Ķ5‡r ‚š1 “ś1 ‰ńŒoŒū“Š—^iŠ³ŽŅó‘Ō‚É‚ę‚čÅ‘å1“ś10‡r ‚Ü‚Å‘—Ź‰Ā”\jCÅ‘å6 “śŠŌ‚š–ŚˆĄ‚Ę‚µ‚Đꔭ•i‚Ęˆź•”‚ĢŒć”­•i‚Å•ŪŒÆ‰ŗ‚É‚ÄŽg—p‚Ŗ‰Ā”\‚Ę‚Č‚Į‚½B–{–M‚ɂ؂Ƃ鐄§—p—ŹCŽg—p•ū–@‚É‚Ā‚¢‚Ä‚Ķ–¢‚¾ŒŸŲ’iŠK‚Å‚ ‚邽‚߁C“KŲ‚ČŠ³ŽŅ‚ɐTd‚É“Š—^‚·‚邱‚Ę‚Ŗ–]‚Ü‚ź‚éBTd“Š—^‚·‚ׂ«Š³ŽŅ‚Ę‚µ‚Ä‚ĶC“œ”A•aŠ³ŽŅ‚Č‚ē‚Ń‚É‚ŒŒ“œ‚ ‚é‚¢‚Ķ”ģ–ž“™‚Ģ“œ”A•a‚ĢŠėŒÆˆöŽq‚š—L‚·‚銳ŽŅ‚Å‚ ‚čCŽg—p‚ɍŪ‚µ‚Ä‚Ķ•›ģ—p‚ĢŒX–°‚āŒŒ“œćø‚ɏ\•Ŗ’ˆÓ‚·‚éB‚—īŽŅ‚Ö‚Ģ“Š—^‚ąTd‚ɍs‚¤‚ׂ«‚Å‚ ‚éBģ—p“_‚Ŗd•”‚·‚éƒhƒpƒ~ƒ“D2 Žó—e‘ĢhR–ņƒhƒ“ƒyƒŠƒhƒ“CƒƒgƒNƒƒvƒ‰ƒ~ƒhCƒnƒƒyƒŠƒh[ƒ‹CƒŠƒXƒyƒŠƒhƒ“‚Č‚Ē‚Ę‚Ģ•¹—p‚ĶŠ©‚ß‚ē‚ź‚øC‚Ü‚½C‡–°–ņ‚Ę‚Ģ•¹—p‚É‚Ķ’ˆÓ‚š—v‚·‚éB“Š—^—Ź‚ÉŠÖ‚µ‚Ä‚Ķƒ‰ƒ“ƒ_ƒ€‰»‘ęⅡ ‘ŠŽŽŒ±‚Å‚Ķ‚ ‚é‚ŖC‚“xƒŠƒXƒNR‚Ŗ‚ń–ņ“Š—^‚É‘Ī‚µ3Ü•¹—p‚ɉĮ‚¦‚½ƒIƒ‰ƒ“ƒUƒsƒ“5 ‡r ‚Ę10 ‡r‚Å‚Ķ’x”­Šś‚Ģˆ«SEšq“f‚Ģ§Œä‚É‚Ø‚¢‚Ä“Æ“™‚Å‚ ‚Į‚½‚Ę‚Ģ•ń‚ą‚ ‚é21jB

2j’†“™“xƒŠƒXƒN

Šī–{“I‚É5-HT3Žó—e‘ĢhR–ņ‚ĘƒfƒLƒTƒƒ^ƒ]ƒ“6.6`9.9 mg ‚šĆ’i8`12 mg ‚šŒoŒūj‚Ģ2 Ü•¹—p‚Ę‚·‚é‚ŖCˆź•”‚ĢR‚Ŗ‚ń–ņiƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“CƒCƒzƒXƒtƒ@ƒ~ƒhCƒCƒŠƒmƒeƒJƒ“CƒƒgƒgƒŒƒLƒT[ƒg“™j‚š“Š—^‚·‚鏼‡‚É‚ĶƒAƒvƒŒƒsƒ^ƒ“ƒg125 mg ŒoŒū“Š—^‚ą‚µ‚­‚ĶƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒg150 mg Ć–¬“ą“Š—^‚Ģ•¹—p‚Ŗ„§‚³‚źC‚»‚ĢŪ‚É‚ĶƒfƒLƒTƒƒ^ƒ]ƒ“‚šŒø—ŹiĆ’: 3.3`4.95 mgCŒoŒū: 4`6 mgj‚·‚éiØ§“f–ņŽ”—Ć‚Ģƒ_ƒCƒAƒOƒ‰ƒ€② ŽQĘjB‚Ü‚½C‚ķ‚Ŗ‘‚Å‚Ķ400 —į‚š’“‚¦‚éƒIƒLƒTƒŠƒvƒ‰ƒ`ƒ““Š—^Š³ŽŅ‚É‘Ī‚·‚é‘ęIII‘Šƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚Ŗs‚ķ‚źC5-HT3Žó—e‘ĢhR–ņ‚ĘƒfƒLƒTƒƒ^ƒ]ƒ“•¹—p‰ŗ‚É‚Ø‚¢‚āCƒAƒvƒŒƒsƒ^ƒ“ƒg/ƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒgŒQ‚ŖƒRƒ“ƒgƒ[ƒ‹ŒQ‚ę‚č‘SŽ”—ĆŠśŠŌC“Į‚É’x”­Šś‚Ģˆ«SEšq“f‚Ģ§Œä‚É—D‚ź‚邱‚Ę‚ŖŽ¦‚³‚ź‚½22jB

‚Č‚ØƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒg‚ĢŠCŠO‘ęIII‘Šƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚Ę‚µ‚āC’†“™“xƒŠƒXƒN‚Ģ§“f–ņŽ”—Ć‚É‚Ø‚Æ‚é5-HT3 Žó—e‘ĢhR–ņ‚ĘƒfƒLƒTƒƒ^ƒ]ƒ“•¹—p‚É‘Ī‚·‚éƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒg‚Ģćę‚¹Œų‰Ź‚Ŗ•ń‚³‚ź‚Ä‚¢‚é23jB

ƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“‚Ķˆź”Ź“I‚É‚Ķ’†“™“xƒŠƒXƒN‚ĢR‚Ŗ‚ń–ņ‚É•Ŗ—Ž‚³‚ź‚é‚ŖC‚—p—Ź‚Å‚ĢŽg—p‚ɍŪ‚µ‚Ä‚Ķ“Į‚ÉĆ“f«ƒŠƒXƒN‚Ŗ‚‚­‚Č‚é‚½‚߁C’Źķ‚Ģ’†“™“xƒŠƒXƒN‚ĢR‚Ŗ‚ń–ņ‚Ģˆ«SEšq“f—\–h–@‚Ę‚ĶˆŁ‚Č‚é‚ĘŽv‚ķ‚ź‚éB21 ‚Ģ§“f—Ć–@Œ¤‹†‚Ģƒƒ^ƒAƒiƒŠƒVƒX24j‚Å‚ĶCƒJƒ‹ƒ{ƒvƒ‰ƒ`ƒ“ƒŒƒWƒƒ“‚É‘Ī‚·‚éƒAƒvƒŒƒsƒ^ƒ“ƒgŽg—p‚É‚Ø‚¢‚Ä–¾‚ē‚©‚ɗՏ°“I—L‰v«‚Ŗ‚ ‚Į‚½‚Ę‚³‚źC‹}«E’x”­Šś‚É‚©‚Ƃč‚“xƒŠƒXƒN‚ĢR‚Ŗ‚ń–ņ‚ɏ€‚¶‚½§“f—Ć–@‚šs‚¤‚±‚Ę‚šƒOƒŒ[ƒhB‚Ę‚µ‚Đ„§‚µ‚½B‚Č‚ØNCCNƒKƒCƒhƒ‰ƒCƒ“‚Å‚ĶAUC†4 ‚Ŗ‚“xƒŠƒXƒN‚Ę‚³‚ź‚Ä‚¢‚é‚ŖC‚±‚Ģ‹«ŠE’l4‚ÉŠÖ‚·‚éƒGƒrƒfƒ“ƒX‚Ķ•s–¾‚Å‚ ‚éB

3jŒy“xƒŠƒXƒNiØCQ7 ŽQĘj

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  1. NCCN Clinical Practice Guidelines in Oncology-Antiemesis-ver. 2, 2017
  2. Berger MJ, Ettinger DS, Aston J, et al. NCCN Guidelines Insights: Antiemesis, Version 2.2017. J Natl Compr Canc Netw. 2017; 15: 883-893.
  3. MASCC/ESMO Antiemetic Guidelines 2016
  4. Hesketh PJ, Kris MG, Basch E, Basch E, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017; 35: 3240-61.
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1j Dexamethasone alone or in combination with ondansetron for the prevention of delayed nausea and vomiting induced by chemotherapy. The Italian Group for Antiemetic Research. N Engl J Med. 2000; 342: 1554-9.

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2j Chawla SP, Grunberg SM, Gralla RJ, et al. Establishing the dose of the oral NK1 antagonist aprepitant for the prevention of chemotherapy-induced nausea and vomiting. Cancer. 2003; 97: 2290-300.

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3j Hesketh PJ, Grunberg SM, Gralla RJ, 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: 4112-9.

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4j Navari RM, Reinhardt RR, Gralla RJ, et al. Reduction of cisplatin-induced emesis by a selective neurokinin-1-receptor antagonist. L-754,030 Antiemetic Trials Group. N Engl J Med. 1999 ; 340: 190-195.

5j Campos D, Pereira JR, Reinhardt RR, et al. Prevention of cisplatin-induced emesis by the oral neurokinin-1 antagonist, MK-869, in combination with granisetron and dexamethasone or with dexamethasone alone. J Clin Oncol. 2001; 19: 1759-1767.

6j Barrajon E, de las Peñ as R. Randomised double blind crossover study comparing ondansetron, granisetron and tropisetron. A cost-benefit analysis. Support Care Cancer. 2000; 8: 323-33.

iⅡ j

7j del Giglio A, Soares HP, Caparroz C, et al. Granisetron is equivalent to ondansetron for prophylaxis of chemotherapy-induced nausea and vomiting: results of a meta-analysis of randomized controlled trials. Cancer. 2000; 89: 2301-8.

iⅠ j

8j Jantunen IT, Muhonen TT, Kataja VV, et al. 5-HT3 receptor antagonists in the prophylaxis of acute vomiting induced by moderately emetogenic chemotherapy--a randomised study. Eur J Cancer. 1993; 29A: 1669-72.

iⅡ j

9j Tsavaris N, Kosmas C, Vadiaka M, et al. Ondansentron and dexamethasone treatment with different dosing schedulesi24 versus 32 mgjin patients with non-small-cell lung cancer under cisplatin-based chemotherapy: a randomized study. Chemotherapy. 2000; 46: 364-70.

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10j Fauser AA, Duclos B, Chemaissani A, et al. Therapeutic equivalence of single oral doses of dolasetron mesilate and multiple doses of ondansetron for the prevention of emesis after moderately emetogenic chemotherapy. European Dolasetron Comparative Study Group. Eur J Cancer. 1996; 32A: 1523-9.

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11j Ettinger DS, Eisenberg PD, Fitts D, et al. A double-blind comparison of the efficacy of two dose regimens of oral granisetron in preventing acute emesis in patients receiving moderately emetogenic chemotherapy. Cancer. 1996; 78: 144-51.

iⅡ j

12j Kaizer L, Warr D, Hoskins P, et al. Effect of schedule and maintenance on the antiemetic efficacy of ondansetron combined with dexamethasone in acute and delayed nausea and emesis in patients receiving moderately emetogenic chemotherapy: a phase III trial by the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 1994; 12: 1050-7.

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13j Aapro MS, Grunberg SM, Manikhas GM, et al. A phase III, double-blind, randomized trial of palonosetron compared with ondansetron in preventing chemotherapy-induced nausea and vomiting following highly emetogenic chemotherapy. Ann Oncol. 2006; 17: 1441-9.

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14j Saito M, Aogi K, Sekine I, et al. Palonosetron plus dexamethasone versus granisetron plus dexamethasone for prevention of nausea and vomiting during chemotherapy: a double-blind, double-dummy, randomised, comparative phase III trial. Lancet Oncol. 2009; 10: 115-24.

iⅡ j

15j Grunberg S, Chua D, Maru A, et al. Single-dose fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting associated with cisplatin therapy: randomized, double-blind study protocol--EASE. J Clin Oncol. 2011; 29: 1495-501.

iⅠ j

16j Navari RM, Gray SE, Kerr AC. Olanzapine versus aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a randomized phase III trial. J Support Oncol. 2011; 9: 188-95.

iⅡ j

17j Navari RM, Qin R, Ruddy KJ, et al. Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting. N Engl J Med 2016; 375: 134-142.

iⅠ j

18j Mizukami N, Yamauchi M, Koike K, et al. Olanzapine for the prevention of chemotherapy-induced nausea and vomiting in patients receiving highly or moderately emetogenic chemotherapy: a randomized, double-blind, placebo-controlled study. J Pain Symptom Manage. 2014; 47: 542-50.

19j Abe M, Hirashima Y, Kasamatsu Y, et al. Efficacy and safety of olanzapine combined with aprepitant, palonosetron, and dexamethasone for preventing nausea and vomiting induced by cisplatin-based chemotherapy in gynecological cancer: KCOG-G1301 phase II trial. Support Care Cancer 2016; 24: 675-82.

20j Nakashima K, Murakami H, Yokoyama K, et al. A Phase II study of palonosetron, aprepitant, dexamethasone and olanzapine for the prevention of cisplatin-based chemotherapy-induced nausea and vomiting in patients with thoracic malignancy. Jpn J Clin Oncol. 2017; 47: 840-843.

iⅡ j

21j Yanai T, Iwasa S, Hashimoto H, et al. A double-blind randomized phase II dose-finding study of olanzapine 10 mg or 5 mg for the prophylaxis of emesis induced by highly emetogenic cisplatin-based chemotherapy. Int J Clin Oncol. 2018; 23: 382-388.

22j Nishimura J, Satoh T, Fukunaga M, et al. Combination antiemetic therapy with aprepitant/fosaprepitant in patients with colorectal cancer receiving oxaliplatin-based chemotherapyiSENRI trialj: A multicentre, randomised, controlled phase 3 trial. Eur J Cancer. 2015; 51: 1274-82.

iⅡ j

23j Weinstein C, Jordan K, Green SA, et al. Single-dose fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting associated with moderately emetogenic chemotherapy: results of a randomized, double-blind phase III trial. Ann Oncol 2016; 27: 172-8.

iⅡ j

24j Jordan K, Blä ttermann L, Hinke A, et al. Is the addition of a neurokinin-1 receptor antagonist beneficial in moderately emetogenic chemotherapy?-a systematic review and meta-analysisDSupport Care Cancer 2018; 26: 21-32


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1j Kaizer L, Warr D, Hoskins P, et al. Effect of schedule and maintenance on the antiemetic efficacy of ondansetron combined with dexamethasone in acute and delayed nausea and emesis in patients receiving moderately emetogenic chemotherapy: A phase III trial by the National Cancer Institute of Canada Clinical Trial Group. J Clin Oncol. 1994; 12: 1050- 7.

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5j Kris MG, Radford JE, Pizzo BA, et al. Use of an NK1 receptor antagonist to prevent delayed emesis after cisplatin. J Natl Cancer Inst. 1997; 89: 817-8.

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6j Schmoll HJ, Aapro MS, 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: 1000-6.

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28j Lindley C, Goodin S, McCune J, et al. Prevention of delayed chemotherapy-induced nausea and vomiting after moderately high to highly emetogenic chemotherapy: comparison of ondansetron, prochlorperazine, and dexamethasone. Am J Clin Oncol. 2005; 28: 270-6.

iⅡ j

29j Jordan K, Jahn F, Aapro M. Recent developments in the prevention of chemotherapy-induced nausea and vomiting iCINVj: a comprehensive review. Ann Oncol. 2015; 26: 1081-90.

iⅠ j

30j Rapoport BL, Jordan K, Boice JA, et al. Aprepitant for the prevention of chemotherapy-induced nausea and vomiting associated with a broad range of moderately emetogenic chemotherapies and tumor types: a randomized, double-blind study. Support Care Cancer. 2010; 18: 423-31.

iⅡ j

31j Nishimura J, Satoh T, Fukunaga M, et al. Combination antiemetic therapy with aprepitant/fosaprepitant in patients with colorectal cancer receiving oxaliplatin-based chemotherapyiSENRI trialj: a multicentre, randomised, controlled phase 3 trial. Eur J Cancer. 2015; 51: 1274-82.

iⅡ j

32j Weinstein C, Jordan K, Green SA,et al. Single-dose fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting associated with moderately emetogenic chemotherapy: results of a randomized, double-blind phase III trial. Ann Oncol. 2016; 27: 172-8.

iⅡ j

33j Yahata H, Kobayashi H, Sonoda K, et al. Efficacy of aprepitant for the prevention of chemotherapy-induced nausea and vomiting with a moderately emetogenic chemotherapy regimen: a multicenter, placebo-controlled, double-blind, randomized study in patients with gynecologic cancer receiving paclitaxel and carboplatin. Int J Clin Oncol. 2016; 21: 491-7.

iⅡ j

34j Tanioka M, Kitao A, Matsumoto K, et al. A randomised, placebo-controlled, double-blind study of aprepitant in nondrinking women younger than 70 years receiving moderately emetogenic chemotherapy. Br J Cancer 2013; 109: 859-865.

iⅡ j

35j Ito Y, Karayama M, Inui N, et al. Aprepitant in patients with advanced non-small-cell lung cancer receiving carboplatin-based chemotherapy. Lung Cancer 2014; 84: 259-264.

iⅡ j

36j Kusagaya H, Inui N, Karayama M, et al. Evaluation of palonosetron and dexamethasone with or without aprepitant to prevent carboplatin-induced nausea and vomiting in patients with advanced non-small-cell lung cancer. Lung Cancer 2015; 90: 410-416.

iⅡ j

37j Fonte C, Fatigoni S, Roila F. A review of olanzapine as an antiemetic in chemotherapy-induced nausea and vomiting and in palliative care patients. Crit Rev Oncol Hematol. 2015; 95: 214-21.

iⅠ j

38j Nagashima K, Iwasa S, Yanai T, et al. A double-blind randomized phase Ⅱ study of olanzapine 10 mg versus 5 mg for emesis induced by highly emetogenic chemotherapy. Jpn J Clin Oncol. 2015; 45: 229-31.

iⅡ j

39j Navari RM, Nagy CK, Gray SE. The use of olanzapine versus metoclopramide for the treatment of breakthrough chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy. Support Care Cancer. 2013; 21: 1655-63.

iⅡ j

40j Navari RM, Einhorn LH, Passik SD, et al. A phase Ⅱ trial of olanzapine for the prevention of chemotherapy-induced nausea and vomiting: a Hoosier Oncology Group study. Support Care Cancer. 2005; 13: 529-34.

iⅡ j

41j Navari RM, Einhorn LH, Loehrer PJ Sr, et al. A phase Ⅱ trial of olanzapine, dexamethasone, and palonosetron for the prevention of chemotherapy-induced nausea and vomiting: a Hoosier oncology group study. Support Care Cancer. 2007; 15: 1285-91.

iⅡ j

42j Tan L, Liu J, Liu X, et al. Clinical research of Olanzapine for prevention of chemotherapy-induced nausea and vomiting. J Exp Clin Cancer Res. 2009; 28: 131.

iⅡ j

43j Navari RM, Gray SE, Kerr AC. Olanzapine versus aprepitant for the prevention of chemotherapy- induced nausea and vomiting: a randomized phase III trial. J Support Oncol. 2011; 9: 188-95.

iⅡ j

44j Navari RM, Qin R, Ruddy KJ, et al. Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting. N Engl J Med 2016; 375: 134-142.

iⅠ j

45j Mizukami N, Yamauchi M, Koike K, et al. Olanzapine for the prevention of chemotherapy-induced nausea and vomiting in patients receiving highly or moderately emetogenic chemotherapy: a randomized, double-blind, placebo-controlled study. J Pain Symptom Manage. 2014; 47: 542-50.

iⅡ j

46j Abe M, Hirashima Y, Kasamatsu Y, et al. Efficacy and safety of olanza- pine combined with aprepitant, palonosetron, and dexamethasone for preventing nausea and vomiting induced by cisplatin-based chemotherapy in gynecological cancer: KCOG-G1301 phase II trial. Support Care Cancer 2016; 24: 675-82.

47j Nakashima K, Murakami H, Yokoyama K, et al. A Phase II study of palonosetron, aprepitant, dexamethasone and olanzapine for the prevention of cisplatin-based chemotherapy-induced nausea and vomiting in patients with thoracic malignancy. Jpn J Clin Oncol. 2017; 47: 840-843.

iⅡ j

48j Yanai T, Iwasa S, Hashimoto H, et al. A double-blind randomized phase II dose-finding study of olanzapine 10 mg or 5 mg for the prophylaxis of emesis induced by highly emetogenic cisplatin-based chemotherapy. Int J Clin Oncol. 2018; 23: 382-388.


Clinical QuestionE„§ˆź——‚Ö


CQ4
‘ę1/2 ¢‘ć‚Ģ5-HT3Žó—e‘ĢhR–ņ‚š‚Ē‚Ģ‚ꂤ‚ÉŽg‚¢•Ŗ‚Æ‚é‚©

„§ƒOƒŒ[ƒh

C1 ‚“xƒŠƒXƒNR‚Ŗ‚ń–ņi50 mg/m2–¢–ž‚ĢƒVƒXƒvƒ‰ƒ`ƒ“‚šœ‚­j‚É‘Ī‚·‚éCINV ‚Ģ—\–h‚Ę‚µ‚āCNK1Žó—e‘ĢhR–ņ{5-HT3 Žó—e‘ĢhR–ņi1 “ś–Śj{ƒfƒLƒTƒƒ^ƒ]ƒ“i1`4 “ś–Śj‚Ģ3 Ü•¹—p‚É‚ĶC‘ę2 ¢‘ć5-HT3Žó—e‘ĢhR–ņ‚ŖD‚Ü‚ź‚éB
C1 ’†“™“xƒŠƒXƒN‚É•Ŗ—Ž‚³‚ź‚éR‚Ŗ‚ń–ņ‚Å‚ ‚é‚ŖCĆ“f«‚Ģ‚‚¢ƒŒƒWƒƒ“‚É‘Ī‚·‚éCINV ‚Ģ—\–h‚Ę‚µ‚āCNK1Žó—e‘ĢhR–ņ‚š—p‚¢‚鏼‡‚É‚Ķ‘ę1 ¢‘ć‚Ģ5-HT3Žó—e‘ĢhR–ņ‚Ŗ„§‚³‚źCNK1Žó—e‘ĢhR–ņ‚š—p‚¢‚Č‚¢ź‡‚É‚Ķ‘ę2 ¢‘ć‚Ģ5-HT3Žó—e‘ĢhR–ņ‚ŖD‚Ü‚ź‚éB
+ ”wŒiE–Ś“I

‚³‚Ü‚“‚܂Ȑ§“f–ņ‚Ŗ•‹y‚µ‚½‚±‚Ę‚É”ŗ‚¢C‹}«Šś‚Ģˆ«SEšq“f‚ĢƒRƒ“ƒgƒ[ƒ‹‚Ķ”äŠr“I—ĒD‚Ę‚Č‚Į‚½‚½‚߁C’x”­«ˆ«SEšq“f‚Ö‚Ģ‘Īō‚ŖV‚½‚ȉŪ‘č‚Å‚ ‚é‚Ę‚¢‚¦‚é1jB’x”­«ˆ«SEšq“f‚ĶC‚“xƒŠƒXƒN‚ĢR‚Ŗ‚ń–ņiHECj‚š—p‚¢‚鏼‡‚¾‚Æ‚Å‚Č‚­C’†“™“xƒŠƒXƒN‚ĢR‚Ŗ‚ń–ņiMECj‚É‚Ø‚¢‚Ä‚ą•¹—p‚Č‚Ē‚É‚ę‚čĆ“f«‚Ģ‚‚¢ƒŒƒWƒƒ“‚š—p‚¢‚鏼‡‚É–ā‘č‚Ę‚Č‚éB

’x”­«ˆ«SEšq“f‚É‘Ī‚·‚鐧“f–ņ‚Ę‚µ‚āCƒfƒLƒTƒƒ^ƒ]ƒ“C5-HT3Žó—e‘ĢhR–ņCNK1Žó—e‘ĢhR–ņ‚Ŗ‚ ‚éiØCQ3 ŽQĘjB‹ß”NC‘ę2 ¢‘ć‚Ģ5-HT3Žó—e‘ĢhR–ņiƒpƒƒmƒZƒgƒƒ“j‚Ŗ—Տ°“±“ü‚³‚źCASCOi2011 ”NjCMASCC/ESMOi2010 ”Nj‚ĢƒKƒCƒhƒ‰ƒCƒ“‚Å‚ĶCHEC ‚É‚ĶƒAƒvƒŒƒsƒ^ƒ“ƒgiƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒgj{5-HT3Žó—e‘ĢhR–ņ{ƒfƒLƒTƒƒ^ƒ]ƒ“‚Ģ3 Ü•¹—p‚š„§‚µC‘ę2¢‘ć5-HT3Žó—e‘ĢhR–ņ‚Å‚ ‚éƒpƒƒmƒZƒgƒƒ“‚ŖD‚Ü‚µ‚¢‚Ę‚µ‚Ä‚¢‚½B

‘ę1 ¢‘ć‚Ę‘ę2 ¢‘ć‚Ģ5-HT3Žó—e‘ĢhR–ņ‚š”äŠr‚µ‚½‚³‚Ü‚“‚Ü‚Č—Õ°ŽŽŒ±‚Ŗs‚ķ‚ź‚½‚ŖCˆČ‰ŗ‚ÉŽ¦‚·‚ꂤ‚É3 Ü•¹—p§“f—Ć–@‚É‚Ø‚¢‚Ä‚ĶC‘ę1 ¢‘ć‚É”ä‚ׂđę2 ¢‘ć‚Ŗ–¾‚ē‚©‚É—D‚ź‚Ä‚¢‚邱‚Ę‚šŽ¦‚·Šm‚½‚éƒGƒrƒfƒ“ƒX‚Ķ‚Č‚¢B‚µ‚©‚µC’x”­«ˆ«SEšq“f‚Ģ—\–h–Ś“I‚ɐ§“f–ņ‚š‘I‘š‚·‚éŪ‚É‚ĶCR‚Ŗ‚ń–ņ‚²‚Ę‚ĢĆ“f«‚ĢƒŠƒXƒN•Ŗ—Ž‚É‚Ę‚Ē‚Ü‚ē‚øƒŒƒWƒƒ“‚ĢĆ“f«ƒŠƒXƒN‚š”FŽÆ‚µ‚āCŠ³ŽŅ‚ĢƒŠƒXƒNiØCQ11 ŽQĘj‚ā•¹‘¶Ē‚šl—¶‚µC‚Ü‚½–ņÜ”ļ‚š‰Į–”‚µ‚āCƒfƒLƒTƒƒ^ƒ]ƒ“CNK1Žó—e‘ĢhR–ņ‚ĢŽg—p‚Ø‚ę‚Ń‘ę1 ¢‘ć‚Ü‚½‚Ķ‘ę2 ¢‘ć‚Ģ5-HT3Žó—e‘ĢhR–ņ‚š‘I‘š‚·‚é•K—v‚Ŗ‚ ‚éB

Ć“f«ƒŠƒXƒN‚ĶR‚Ŗ‚ń–ņ‚²‚Ę‚É’č‚ß‚ē‚źC§“f–ņ‚šŽg—p‚µ‚Č‚¢ź‡‚É30`90“‚ĢŠ„‡‚ň«SEšq“f‚Ŗ¶‚¶‚é‚ą‚Ģ‚ŖMEC ‚É•Ŗ—Ž‚³‚ź‚éBMEC ‚É•Ŗ—Ž‚³‚ź‚éR‚Ŗ‚ń–ņ‚Ķ‚»‚źŽ©‘Ģ‚ĢĆ“f«ƒŠƒXƒN‚Ģ•‚Ŗ‘å‚«‚¢‚¾‚Æ‚Å‚Č‚­C•¹—p—Ć–@‚šŠÜ‚ß‚½ƒŒƒWƒƒ“‚Ģ’†‚É‚ĶC‘ę1 ¢‘ć5-HT3Žó—e‘ĢhR–ņ‚ĘƒfƒLƒTƒƒ^ƒ]ƒ“‚š—p‚¢‚é‚Ģ‚Ż‚Å‚Ł‚Ę‚ń‚Ēˆ«SEšq“f‚Ŗ¶‚¶‚Č‚¢‚ą‚Ģ‚Ŗ‚ ‚éˆź•ū‚ŁCHEC ‚ę‚č’x”­«ˆ«SEšq“f‚ĢƒŠƒXƒN‚Ŗ‚‚¢‚ą‚Ģ‚ą‚ ‚é1jB‚±‚Ģ‚ꂤ‚ÉMEC ‚É•Ŗ—Ž‚³‚ź‚éR‚Ŗ‚ń–ņ‚š—p‚¢‚½‚·‚ׂĂĢƒŒƒWƒƒ“‚É‘Ī‚µ‚āC„§‚³‚ź‚鐧“f–ņ‚Ģ‘g‚Ż‡‚ķ‚¹‚š1 ‚Ā‚ÉŒĄ‚邱‚Ę‚Ķ–³—‚Ŗ‚ ‚é‚ĘŽv‚ķ‚ź‚éB–{ƒKƒCƒhƒ‰ƒCƒ“‚Å‚Ķ‚»‚ź‚¼‚ź‚ĢƒŒƒWƒƒ“‚²‚Ę‚ÉĆ“f«ƒŠƒXƒN‚Ŗ‹LŚ‚³‚ź‚Ä‚¢‚éiØƒŠƒXƒN•Ŗ—Ž‚©‚ē‚Ż‚½‘ŸŠķ‚Ŗ‚ń•Ź‚ĢƒŒƒWƒƒ“ˆź——ŽQĘjB‹t‚ɁC90“‚š’“‚¦‚éĆ“f•p“x‚Ŗ‚ ‚é‚Ę‚³‚ź‚éHEC ‚É•Ŗ—Ž‚³‚ź‚éR‚Ŗ‚ń–ņ‚š—p‚¢‚½ƒŒƒWƒƒ“‚É‚ąC•ŖŠ„‚µ‚ăVƒXƒvƒ‰ƒ`ƒ“‚š—p‚¢‚郌ƒWƒƒ“‚Č‚ĒCHEC ‚É•Ŗ—Ž‚³‚ź‚éR‚Ŗ‚ń–ņ‚š—p‚¢‚½ƒŒƒWƒƒ“‚É‚ąC•ŖŠ„‚µ‚ăVƒXƒvƒ‰ƒ`ƒ“‚š—p‚¢‚郌ƒWƒƒ“‚Č‚ĒCMEC ˆČ‰ŗ‚ĢĆ“f«ƒŠƒXƒN‚É‚Č‚é‚ą‚Ģ‚ą‚ ‚éB‚Ü‚½CŠ³ŽŅ‘¤‚ĢˆöŽq‚Ę‚µ‚āC«•Ź‚ā”N—ī‚Ŗˆ«SEšq“f‚ĢƒŠƒXƒN‚Ę‚µ‚Ä’m‚ē‚ź‚Ä‚¢‚éiØCQ11 ŽQĘjB‚ƒŠƒXƒN‚ĢŠ³ŽŅ‚É‚ĶC–ņÜ‚²‚Ę‚É’č‚ß‚ē‚ź‚½ƒŠƒXƒN‚ę‚č‚ąˆź’iŠK‚‚¢ƒŠƒXƒN‚É‘Ī‚·‚鐧“f—Ć–@‚š—p‚¢‚é‚Č‚ĒC‚ę‚č—LŒų‚ÉCINV ‚š–h‚®•ūō‚šl—¶‚·‚邱‚Ę‚Ŗ‹‚ß‚ē‚ź‚éB‚³‚ē‚ɁC“œ”A•a‚Č‚Ē‚Ģ•¹‘¶Ē‚ąl—¶‚·‚é•K—v‚Ŗ‚ ‚éB

‚Č‚ØC–{€‚Å‚ĶCŠm‚½‚éƒGƒrƒfƒ“ƒX‚Ŗ‚Č‚­ƒRƒ“ƒZƒ“ƒTƒX‚Ŗ“¾‚ē‚ź‚Č‚¢C‚Ü‚½‚ĶŽQĘ‰Ā”\‚Č—Õ°ŽŽŒ±ƒf[ƒ^‚Ŗ‚Č‚¢ź‡‚É‚ĶC–ņÜ”ļ‚š‰Į–”‚µ‚Ä‘ę1 ¢‘ć‚šu„§‚·‚év‚Ę‚µ‚½B‹t‚ɁC‘ę2 ¢‘ć‚Ŗ‘ę1 ¢‘ć‚ę‚č–¾‚ē‚©‚É—L—˜‚ČƒGƒrƒfƒ“ƒX‚Ķ‚Č‚¢‚ŖC“ńŽŸ•]‰æ€–Ś‚āƒTƒuƒZƒbƒg‰šĶ‚ĢŒ‹‰Ź‚É‚ę‚čƒRƒ“ƒZƒ“ƒTƒX‚Ŗ“¾‚ē‚ź‚鏼‡‚É‚ĶC‘ę2 ¢‘ć‚šuD‚Ü‚ź‚év‚Ę‚µ‚½B

+ ‰šą
1j’PÜ‚ÅHEC ‚É•Ŗ—Ž‚³‚ź‚é–ņÜ‚š—p‚¢‚鏼‡

i1jHECiƒVƒXƒvƒ‰ƒ`ƒ“‚Å‚ ‚ź‚Ī50 mg/m2ˆČćj

HECiƒVƒXƒvƒ‰ƒ`ƒ“‚Å‚ ‚ź‚Ī50 mg/m2ˆČćj‚š—p‚¢‚鏼‡‚É‚ĶCNK1Žó—e‘ĢhR–ņ{5-HT3 Žó—e‘ĢhR–ņi1 “ś–Śj{ƒfƒLƒTƒƒ^ƒ]ƒ“i1`4 “ś–Śj‚Ģ3 Ü•¹—p‚Ŗ„§‚³‚źiØCQ2 ŽQĘjC‘ę2¢‘ć‚Ģ5-HT3 Žó—e‘ĢhR–ņ‚ŖD‚Ü‚ź‚éB

NK1 Žó—e‘ĢhR–ņ‚Ŗ“oź‚·‚éˆČ‘O‚ɍs‚ķ‚ź‚½ŽŽŒ±‚Å‚ĶC‘ę1 ¢‘ć5-HT3 Žó—e‘ĢhR–ņ‚É”ä‚ׁCƒpƒƒmƒZƒgƒƒ“‚Ģ“Į‚É’x”­Šś‚ɂ؂Ƃ鐧“fŒų‰Ź‚Ģ—D‰z«‚ŖŽ¦‚³‚ź‚½2j3jB‚»‚ĢŒćCTRIPLE ŽŽŒ±4j‚É‚Ø‚¢‚ÄNK1 Žó—e‘ĢhR–ņ‚šHEC ‚É‘Ī‚µ‚Ä•¹—p‚µ‚½ź‡‚Ģ‘ę2 ¢‘ć5-HT3 Žó—e‘ĢhR–ņiƒpƒƒmƒZƒgƒƒ“j‚Ģ‘ę1 ¢‘ć5-HT3 Žó—e‘ĢhR–ņiƒOƒ‰ƒjƒZƒgƒƒ“j‚É‘Ī‚·‚é—D‰z«‚ŖŒŸ“¢‚³‚ź‚½B

TRIPLE ŽŽŒ±‚ĶC‚—p—Źi50 mg/m2ˆČćj‚ĢƒVƒXƒvƒ‰ƒ`ƒ“‚šŠÜ‚ŽR‚Ŗ‚ń–ņŽ”—Ć‚šs‚¤Ū‚ĢƒAƒvƒŒƒsƒ^ƒ“ƒgCƒfƒLƒTƒƒ^ƒ]ƒ“C5-HT3 Žó—e‘ĢhR–ņ‚Ģ3 Ü•¹—p‚Ģ§“f—Ć–@‚É‚Ø‚¢‚āC‘ę2 ¢‘ć5-HT3Žó—e‘ĢhR–ņiƒpƒƒmƒZƒgƒƒ“j‚Ģ‘ę1 ¢‘ć5-HT3 Žó—e‘ĢhR–ņiƒOƒ‰ƒjƒZƒgƒƒ“j‚É‘Ī‚·‚é—D‰z«‚šŒŸŲ‚·‚é–Ś“I‚ŁC800 –¼‚š’“‚¦‚銳ŽŅ‚š‘g‚Ż“ü‚ź‚½—Տ°ŽŽŒ±‚Å‚ ‚éBˆźŽŸ•]‰æ€–Ś‚Å‚ ‚é5 “śŠŌ‚Ģšq“fŠ®‘S§ŒäŠ„‡išq“f‚ʐ§“f–ņ‚Ģ’Ē‰Į“ą•ž‚Č‚µ‚ĢŠ„‡j‚Å‚ĶC—LˆÓ·‚Ķ‚Č‚¢‚ą‚Ģ‚ĢƒpƒƒmƒZƒgƒƒ“ŒQ‚Ŗ—ĒD‚ČŒXŒü‚É‚ ‚čiƒpƒƒmƒZƒgƒƒ“ŒQ66“CƒOƒ‰ƒjƒZƒgƒƒ“ŒQ59“Cp0.0539jC“ńŽŸ•]‰æ€–Ś‚Å‚ ‚é’x”­Šś‚Ģˆ«SEšq“f‚Å‚ąƒpƒƒmƒZƒgƒƒ“ŒQ‚Ŗ—ĒD‚Å‚ ‚Į‚½iƒpƒƒmƒZƒgƒƒ“ŒQ67“CƒOƒ‰ƒjƒZƒgƒƒ“ŒQ59“Cp0.0142jB

i2j50 mg/m2–¢–ž‚ĢƒVƒXƒvƒ‰ƒ`ƒ“•¹—pƒŒƒWƒƒ“

50 mg/m2–¢–ž‚ĢƒVƒXƒvƒ‰ƒ`ƒ“‚Ķ50 mg/m2ˆČć‚Ę”ä‚ׁCĆ“f«‚Ŗ’į‚¢‚±‚Ę‚Ŗ’m‚ē‚ź‚Ä‚¢‚éiØCQ8 ŽQĘjBƒVƒXƒvƒ‰ƒ`ƒ“‚š•ŖŠ„˜A‘±“Š—^–@i100 mg/m2‚š4`5 “śŠŌj‚Å—p‚¢‚鏼‡‚É‚ĶCƒVƒXƒvƒ‰ƒ`ƒ““Š—^‘O‚É‘ę1 ¢‘ć‚Ģ5-HT3Žó—e‘ĢhR–ņ‚ĘƒfƒLƒTƒƒ^ƒ]ƒ“‚š˜A“ś“Š—^‚·‚éB‚Ü‚½CƒVƒXƒvƒ‰ƒ`ƒ“‚Ģ•ŖŠ„ŠŌŒ‡“Š—^–@iƒ50 mg/m2‚šT1 ‰ńC“™j‚É‚Ø‚¢‚ÄNK1Žó—e‘ĢhR–ņ‚š—p‚¢‚鏼‡‚É‚ĶC‘ę1 ¢‘ć5-HT3Žó—e‘ĢhR–ņ‚ĢŽg—p‚Ŗ„§‚³‚ź‚éB

2j’PÜ‚ÅMEC ‚É•Ŗ—Ž‚³‚ź‚é–ņÜ‚š—p‚¢‚鏼‡

i1j •¹—p‚É‚ę‚čĆ“f«‚Ŗ‚‚܂郌ƒWƒƒ“‚É‘Ī‚µ‚āCNK1Žó—e‘ĢhR–ņ‚š•¹—p‚·‚鏼‡

NK1 Žó—e‘ĢhR–ņ‚š•¹—p‚·‚鏼‡‚É‚ĶC5-HT3Žó—e‘ĢhR–ņ‚š‘ę1 ¢‘ć‚Ę‚·‚é‚©‘ę2 ¢‘ć‚Ę‚·‚é‚©‚É‚Ā‚¢‚Ä‚ĢƒGƒrƒfƒ“ƒX‚Ŗ‚Č‚¢‚½‚߁C]—ˆ’Ź‚čˆć—ĆŒoĻ–Ź‚šl—¶‚µ‘ę1¢‘ć‚Ģ5-HT3 Žó—e‘ĢhR–ņ‚Ŗ„§‚³‚ź‚éB‚½‚¾‚µCŠ³ŽŅ‚Ģˆ«SEšq“fƒŠƒXƒNC•¹‘¶ĒC–ņÜ”ļ‚Č‚Ē‚ąl—¶‚µ‚Ä5-HT3 Žó—e‘ĢhR–ņ‚š‘I‘š‚·‚ׂ«‚Å‚ ‚éB

i2j•¹—p‚É‚ę‚čĆ“f«‚Ŗ‚‚܂郌ƒWƒƒ“‚É‘Ī‚µ‚āCNK1Žó—e‘ĢhR–ņ‚š•¹—p‚µ‚Č‚¢ź‡

MEC ‚É•Ŗ—Ž‚³‚ź‚éR‚Ŗ‚ń–ņ‚Å‚ ‚é‚Ŗ’x”­«ˆ«SEšq“f‚Ŗ–ā‘č‚É‚Č‚éĆ“f«ƒŠƒXƒN‚Ģ‚‚¢ƒŒƒWƒƒ“‚šŽg—p‚·‚éŪ‚ÉNK1 Žó—e‘ĢhR–ņ‚š•¹—p‚µ‚Č‚¢ź‡‚É‚ĶCƒpƒƒmƒZƒgƒƒ“‚ŖD‚Ü‚ź‚éB

•””‚Ģƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚Ę‚»‚ź‚ē‚š“‡‰šĶ‚µ‚½ƒƒ^ƒAƒiƒŠƒVƒX‚ĢŒ‹‰ŹCMEC ‚É‚Ø‚¢‚Ä‘ę1 ¢‘ć5-HT3Žó—e‘ĢhR–ņ‚É”ä‚בę2 ¢‘ć‚Ģ5-HT3Žó—e‘ĢhR–ņ‚Ģ§“fģ—p‚É‚Ø‚Æ‚é—D‰z«‚ŖŽ¦‚³‚ź‚Ä‚¢‚é5jB‚µ‚©‚µCŒĀX‚Ģ—Տ°Œ¤‹†‚É‚Ø‚¢‚āCƒfƒLƒTƒƒ^ƒ]ƒ“‚Ŗ•¹—p‚³‚ź‚Ä‚¢‚Č‚¢C‚ ‚é‚¢‚Ķ•¹—p‚µ‚Ä‚¢‚銄‡‚Ŗ’į‚¢‚Č‚Ē‚Ģ–ā‘č“_‚ŖŽw“E‚³‚ź‚Ä‚Ø‚čCƒfƒLƒTƒƒ^ƒ]ƒ“‚š—p‚¢‚½ó‹µ‰ŗ‚ÅMEC ‚É‘Ī‚·‚éƒpƒƒmƒZƒgƒƒ“‚Ģ—D‰z«‚šŽ¦‚·Šm‚½‚éƒGƒrƒfƒ“ƒX‚Ŗ‚Č‚¢‚±‚Ę‚É’ˆÓ‚Ŗ•K—v‚Å‚ ‚éB

‚Ü‚½C“œ”A•a‚Č‚Ē‚Ģ•¹‘¶Ē‚É‚ę‚Į‚ăfƒLƒTƒƒ^ƒ]ƒ“‚ĢŽg—p‚Ŗ§ŒĄ‚³‚ź‚鏼‡CƒpƒƒmƒZƒgƒƒ“‚É‚ę‚č2`3 “ś–Ś‚ĢƒfƒLƒTƒƒ^ƒ]ƒ“‚šČ—Ŗ‚Å‚«‚é6j7jB

i3j‚»‚Ģ‘¼‚ĢMEC ‚š—p‚¢‚鏼‡

ć‹L‚Ģ‚ꂤ‚ɁCMEC ‚É•Ŗ—Ž‚³‚ź‚éR‚Ŗ‚ń–ņ‚š—p‚¢‚½Ć“f«‚Ģ‚‚­‚Č‚¢ƒŒƒWƒƒ“‚É‘Ī‚µCĻ‹É“I‚É‘ę2 ¢‘ć‚Ģ5-HT3Žó—e‘ĢhR–ņ‚š„§‚·‚éŠm‚½‚éƒGƒrƒfƒ“ƒX‚Ķ‚Č‚¢B‚µ‚½‚Ŗ‚Į‚āCƒfƒLƒTƒƒ^ƒ]ƒ“i1`3 “ś–Śj‚Ę‚Ģ•¹—p‚É‚Ø‚¢‚āC‘ę1 ¢‘ć5-HT3Žó—e‘ĢhR–ņi1 “ś–Śj‚Ŗ„§‚³‚ź‚éB‚½‚¾‚µC“œ”A•a‚Č‚Ē‚Ģ•¹‘¶Ē‚É‚ę‚Į‚ăfƒLƒTƒƒ^ƒ]ƒ“‚ĢŽg—p‚Ŗ§ŒĄ‚³‚ź‚鏼‡C2`3 “ś–Ś‚ĢƒfƒLƒTƒƒ^ƒ]ƒ“‚šČ—Ŗ‚·‚é–Ś“I‚ŃpƒƒmƒZƒgƒƒ“‚š—p‚¢‚é‘I‘šŽˆ‚Ŗ‚ ‚é6j7jB

+ ŽQl‚É‚µ‚½“ńŽŸŽ‘—æ
  1. MASCC/ESMO Antiemetic Guidelines 2016
  2. Hesketh PJ, Kris MG, Basch E, Basch E, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017; 35: 3240-61.
ŽQl•¶Œ£
i jƒGƒrƒfƒ“ƒXƒŒƒxƒ‹

1j Tamura K, Aiba K, Saeki T, et al. Testing the effectiveness of antiemetic guidelines: results of a prospective registry by the CINV Study Group of Japan. Int J Clin Oncol. 2015. mEpub ahead of printn

iIIIj

2j Saito M, Aogi K, Sekine I, et al. Palonosetron plus dexamethasone versus granisetron plus dexamethasone for prevention of nausea and vomiting during chemotherapy: a double-blind, double-dummy, randomised, comparative phase III trial. Lancet Oncol. 2009; 10: 115-24.

iⅡ j

3j Aapro MS, Grunberg SM, Manikhas GM et al. A phase III, double-blind, randomized trial of palonosetron compared with ondansetron in preventing chemotherapy-induced nausea and vomiting following highly emetogenic chemotherapy. Ann Oncol. 17: 1441-9,2006

4j Suzuki K, Yamanaka T, Hashimoto H et al. Randomized, double-blind, phase III trial of palonosetron versus granisetron in the triplet regimen for preventing chemotherapy-induced nausea and vomiting after highly emetogenic chemotherapy: TRIPLE study. Ann Oncol. 27 : 1601-6, 2016

iⅡ j

5j Popovic M, Warr DG, Deangelis C, et al. Efficacy and safety of palonosetron for the prophylaxis of chemotherapy-induced nausea and vomiting iCINVj: a systematic review and meta-analysis of randomized controlled trials. Support Care Cancer. 2014; 22: 1685-97.

iⅠ j

6j Celio L, Frustaci S, Denaro A, et al. Palonosetron in combination with 1-day versus 3-day dexamethasone for prevention of nausea and vomiting following moderately emetogenic chemotherapy: a randomized, multicenter, phase III trial. Support Care Cancer. 2011; 19: 1217-25.

iⅡ j

7j Komatsu Y, Okita K, Yuki S, et al. Open-label, randomized, comparative, phase III study on effects of reducing steroid use in combination with Palonosetron. Cancer Sci. 2015; 106: 891-5.

iⅡ j


Clinical QuestionE„§ˆź——‚Ö


CQ5
ˆ«SEšq“f‚Ģ—\–h‚É‘Ī‚µ‚Ä•›t”ēŽæƒXƒeƒƒCƒh‚ĶŠ©‚ß‚ē‚ź‚é‚©

„§ƒOƒŒ[ƒh

A ‚Ŗ‚ń–ņ•Ø—Ć–@‚É‚ę‚鈫SEšq“f‘Īō‚Ę‚µ‚Ä•›t”ēŽæƒXƒeƒƒCƒh‚Ķ—LŒų‚Å‚ ‚éB‚½‚¾‚µCR‚Ŗ‚ń–ņ‚ĢĆ“f«ƒŠƒXƒN•Ŗ—Ž‚ʁC•¹—p‚·‚鐧“f–ņ‚ɉž‚¶‚½—p–@E—p—Ź‚Å‚Ģ“Š—^‚šs‚¤‚±‚Ę‚Ŗ„§‚³‚ź‚éB
+ ”wŒiE–Ś“I

•›t”ēŽæƒXƒeƒƒCƒh‚ĶR‚Ŗ‚ń–ņ“Š—^‚É”ŗ‚¤ˆ«SEšq“f‚É‘Ī‚·‚鐧“f–ņ‚Ę‚µ‚Ä–ń25 ”N‘O ‚©‚ē—LŒų«‚ŖŲ–¾‚³‚ź‚Ä‚¢‚é1jB‚µ‚©‚µ‚»‚Ģģ—p‹@˜‚É‚Ā‚¢‚Ä‚ĶCR‚Ŗ‚ń–ņ“Š—^Žž‚Ģ§“f–ņ‚Ę‚µ‚ÄŠJ”­‚³‚ź‚½5-HT3Žó—e‘ĢhR–ņCNK1Žó—e‘ĢhR–ņ‚Ł‚Ē‚É‚Ķ‰š–¾‚³‚ź‚Ä‚¢‚Č‚¢B”‘½‚­‚Ģ•›t”ēŽæƒXƒeƒƒCƒh–ņ‚Ģ‚¤‚æCƒfƒLƒTƒƒ^ƒ]ƒ“‚Ø‚ę‚Ńƒƒ`ƒ‹ƒvƒŒƒhƒjƒ]ƒƒ“‚ĶCR‚Ŗ‚ń–ņ“Š—^Žž‚Ģ§“fŒų‰Ź‚ŖÅ‚ą‚ę‚­ŒŸ“¢‚³‚ź‚Ä‚¢‚é2j3jB‚Č‚ØCƒfƒLƒTƒƒ^ƒ]ƒ“‚ĶR‚Ŗ‚ń–ņ“Š—^‚É”ŗ‚¤ˆ«SEšq“f‚ĢŒų”\EŒų‰Ź‚š—L‚µ‚Ä‚¢‚é—Bˆź‚Ģ•›t”ēŽæƒXƒeƒƒCƒh‚Å‚ ‚éB

+ ‰šą

ˆ«SEšq“f‘Īō‚Ę‚µ‚Ä•›t”ēŽæƒXƒeƒƒCƒh‚ĶC’PÜ‚Ø‚ę‚Ń•¹—p—Ć–@‚Ę‚µ‚Ä—LŒų‚Å‚ ‚čCR‚Ŗ‚ń–ņ‚ĢĆ“f«ƒŠƒXƒN‚ɉž‚¶‚ÄŽg—p‚·‚éB‚ķ‚Ŗ‘‚É‚Ø‚Æ‚éƒfƒLƒTƒƒ^ƒ]ƒ“‚Ģ³”F—p—Ź‚ĶCłÜ‚Å‚Ķ1 “ś4`20 mg ‚š1`2 ‰ń•ŖŠ„C1 “śÅ‘å20 mgC’ŽĖÜ‚Å‚Ķ1 “ś3.3`16.5 mg ‚š1`2 ‰ń•ŖŠ„C1 “śÅ‘å16.5 mg ‚Ü‚Å‚Ę‚³‚ź‚Ä‚¢‚éB‰¢•Ä‚Ģƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚ĢŒ‹‰Ź‚©‚ē‹}«Šś‚É‚ĶƒfƒLƒTƒƒ^ƒ]ƒ“20 mg ‚š•W€“Š—^—Ź‚Ę‚·‚é‚ŖC‚³‚ē‚ɍ‚—p—Ź‚ĢŒų‰Ź‚ÉŠÖ‚µ‚Ä‚»‚Ģ—D‰z«‚ĶŲ–¾‚³‚ź‚Ä‚¢‚Č‚¢B‚ķ‚Ŗ‘‚ɂ؂Ƃ鏭”—į‚Ģ‘ęⅡ ‘ŠŽŽŒ±i1`3 “ś–Ś‚É32 mg/m2‚šĆ’j‚É‚Ø‚¢‚Ä20 mg ˆČć‚Ģ‚—p—ŹƒfƒLƒTƒƒ^ƒ]ƒ“‚š„§‚·‚邾‚Æ‚ĢŒ‹‰Ź‚Ķ“¾‚ē‚ź‚Ä‚¢‚Č‚¢4jB

1j‚“xƒŠƒXƒNR‚Ŗ‚ń–ņ‚šŠÜ‚ŽƒŒƒWƒƒ“

‹}«ˆ«SEšq“f‚É‘Ī‚µ‚āC—\–h“I‚É5-HT3Žó—e‘ĢhR–ņ‚Ę•¹—p‚µ‚ăfƒLƒTƒƒ^ƒ]ƒ“13.2`16.5 mg ‚šĆ’i16`20 mg ‚šŒoŒūj“Š—^‚·‚éB‚½‚¾‚µCNK1Žó—e‘ĢhR–ņƒAƒvƒŒƒsƒ^ƒ“ƒg‚ą‚µ‚­‚ĶƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒg•¹—pŽž‚É‚ĶC‚±‚ź‚ē‚ŖCYP3A4 ‚Ģ‘jŠQģ—p‚š—L‚·‚邽‚߁CCYP3A4 ‚É‚ę‚éƒfƒLƒTƒƒ^ƒ]ƒ“‚Ģ‘ćŽÓ‚Ŗ‘jŠQ‚³‚ź‚邱‚Ę‚šl—¶‚µ‚ăfƒLƒTƒƒ^ƒ]ƒ“‚šŒø—Ź‚·‚éiĆ’: 9.9 mgCŒoŒū: 12 mgj5jB

’x”­«ˆ«SEšq“f‚É‘Ī‚µ‚āC—\–h“I‚ɃfƒLƒTƒƒ^ƒ]ƒ“‚š2`4 “ś–Ś‚É“Š—^‚·‚é‚ŖCƒAƒvƒŒƒsƒ^ƒ“ƒg•¹—pŽž‚É‚Ķ‘ŠŒŻģ—p‚šl—¶‚µ‚Ä8 mg ‚šŒoŒūi6.6 mg ‚šĆ’j“Š—^‚·‚éB‚Č‚ØCƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒg‚Å‚ĶƒfƒLƒTƒƒ^ƒ]ƒ“‚Ę‚Ģ‘ŠŒŻģ—p‚ĢŠśŠŌ‚Ŗ’Z‚¢iØCQ17 ŽQĘjB‹ļ‘Ģ“I‚ČŽg—p‚ɍŪ‚µ‚Ä‚Ķ§“f–ņŽ”—Ć‚Ģƒ_ƒCƒAƒOƒ‰ƒ€① ‚šŽQĘ‚³‚ź‚½‚¢i‘ę1 “ś–ŚĆ –¬“ą“Š—^C2 “ś–ŚˆČ~‚ĶŒoŒū“Š—^‚Ģ—įŽ¦‚Å‚ ‚éjB

2j’†“™“xƒŠƒXƒNR‚Ŗ‚ń–ņ‚šŠÜ‚ŽƒŒƒWƒƒ“

‹}«ˆ«SEšq“f‚É‘Ī‚µ‚āC—\–h“I‚É5-HT3Žó—e‘ĢhR–ņ‚Ę•¹—p‚µ‚ăfƒLƒTƒƒ^ƒ]ƒ“6.6`9.9 mg ‚šĆ’i8`12 mg ‚šŒoŒūj“Š—^‚·‚éBƒAƒvƒŒƒsƒ^ƒ“ƒg‚Ę‚Ģ•¹—pŽž‚É‚ĶƒfƒLƒTƒƒ^ƒ]ƒ“‚šŒø—Ź‚µ3.3`4.95 mg ‚šĆ’i4`6 mg ‚šŒoŒūj‚Ę‚·‚éB

’x”­«ˆ«SEšq“f‚É‘Ī‚µ‚āCƒAƒvƒŒƒsƒ^ƒ“ƒg”ń•¹—pŽž‚É‚Ķ2`3 “ś–Ś‚ɃfƒLƒTƒƒ^ƒ]ƒ“8 mg ‚šŒoŒūi6.6 mg ‚šĆ’j“Š—^‚·‚éBƒpƒƒmƒZƒgƒƒ“‚š1 “ś–Ś‚É0.25 mg ‚ą‚µ‚­‚Ķ0.75 mg “Š—^‚µ‚½Š³ŽŅ‚É‘Ī‚·‚é2`3 “ś–Ś‚ĢƒfƒLƒTƒƒ^ƒ]ƒ““Š—^‚É‚Ā‚¢‚Ä‚ĶC“Š—^Č—Ŗ‚Å‚Ģ”ń—ņ«‚ŖŽ¦‚³‚ź‚Ä‚¢‚é6j`8jB‚µ‚½‚Ŗ‚Į‚āC•›t”ēŽæƒXƒeƒƒCƒhŽg—p‚šl—¶‚·‚ׂ«Š³ŽŅ‚É‚Ø‚¢‚Ä‚ĶC5-HT3Žó—e‘ĢhR–ņ‚ɃpƒƒmƒZƒgƒƒ“‚š—p‚¢‚邱‚Ę‚ÅƒfƒLƒTƒƒ^ƒ]ƒ““Š—^‚šČ—Ŗ‚·‚邱‚Ę‚Ŗ‚Å‚«‚é‚ŖC‚±‚Ģ“_‚É‚Ā‚¢‚ď\•Ŗ‚ɃRƒ“ƒZƒ“ƒTƒX‚Ķ“¾‚ē‚ź‚Ä‚¢‚Č‚¢B‚¢‚ø‚ź‚É‚¹‚ęC“K—pŠ³ŽŅ‚ĢƒŠƒXƒNˆöŽq‚ÉŠī‚Ć‚­Œˆ’č‚Ŗ•K—v‚Å‚ ‚éiØCQ3 ŽQĘjB‹ļ‘Ģ“I‚ČŽg—p‚ɍŪ‚µ‚Ä‚Ķ§“f–ņŽ”—Ć‚Ģƒ_ƒCƒAƒOƒ‰ƒ€② ‚šŽQĘ‚³‚ź‚½‚¢i‘ę1 “ś–ŚĆ–¬“ą“Š—^C2 “ś–ŚˆČ~‚ĶŒoŒū“Š—^C‚ ‚é‚¢‚Ķ‘ę1 “ś–ŚĆ–¬“ą“Š—^‚Ģ‚Ż‚Ģź‡‚Ģ—įŽ¦‚Å‚ ‚éjB

3jŒy“xƒŠƒXƒNR‚Ŗ‚ń–ņ‚šŠÜ‚ŽƒŒƒWƒƒ“

—\–h“I‚ɁCƒfƒLƒTƒƒ^ƒ]ƒ“’PÜ‚ ‚é‚¢‚Ķ5-HT3Žó—e‘ĢhR–ņ‚Ę•¹—p‚·‚éB‚»‚ĢŪ‚ĶƒfƒLƒTƒƒ^ƒ]ƒ“3.3`6.6 mg ‚šĆ’i4`8 mg ‚šŒoŒūj“Š—^‚·‚éBR‚Ŗ‚ń–ņ‚Ģ—p—Ź•ŖŠ„“Š—^‚É‘Ī‚µ‚Ä‚ĶC—\–h“I‚Č”½•œ“Š—^‚šs‚¤‚±‚Ę‚Ŗ‚Å‚«‚éB‹ļ‘Ģ“I‚ČŽg—p‚ɍŪ‚µ‚Ä‚Ķ§“f–ņŽ”—Ć‚Ģƒ_ƒCƒAƒOƒ‰ƒ€③ ‚šŽQĘ‚³‚ź‚½‚¢i‘ę1 “ś–ŚĆ–¬“ą“Š—^‚Ģ‚Ż‚Ģ—įŽ¦‚Å‚ ‚éjB

4jÅ¬“xƒŠƒXƒNR‚Ŗ‚ń–ņ‚šŠÜ‚ŽƒŒƒWƒƒ“

—\–h“I‚Č•›t”ēŽæƒXƒeƒƒCƒh“Š—^‚Ķ•s—v‚Å‚ ‚éB

5j—\Šś«ˆ«SEšq“f

—\–h“I‚Č•›t”ēŽæƒXƒeƒƒCƒh‚Ģ—L—p«‚Ķ–¾‚ē‚©‚Å‚Č‚¢B

6j‚»‚Ģ‘¼

‚Ŗ‚ń–ņ•Ø—Ć–@ƒŒƒWƒƒ“Ž©‘Ģ‚É•›t”ēŽæƒXƒeƒƒCƒh‚šŠÜ‚Žź‡‚ĶC§“f–ņ‚Ę‚µ‚Ä‚ĢƒfƒLƒTƒƒ^ƒ]ƒ“‚Ķ’Ē‰Į‚µ‚Č‚¢B

–{ƒKƒCƒhƒ‰ƒCƒ“‚Ģ„§‚ɏ]‚¢C‚Ŗ‚ń–ņ•Ø—Ć–@Žž‚Ģ§“f–ņ‚Ę‚µ‚Ä’ZŠśŠŌŽg—p‚·‚é•›t”ēŽæƒXƒeƒƒCƒh‚ĢˆĄ‘S«‚ÉŠÖ‚µ‚Ä‚Ķ‹–—e”ĶˆĶ“ą‚Ę‚³‚ź‚Ä‚¢‚é‚ŖC‚»‚Ģ•›ģ—p‚É‚Ā‚¢‚ď\•Ŗ—‰š‚µ‚½ć‚ÅŽg—p‚·‚éiAppendix §“f–ņ‚Ģ•›ģ—pŽQĘjB

R‚Ŗ‚ń–ņ‚É‚ę‚é“Ėo«‚Ģˆ«SEšq“fĒó‚É‘Ī‚µ‚āCŽ”—Ć“I’Ē‰Į–ņ‚Ę‚µ‚Ä‚ĢƒfƒLƒTƒƒ^ƒ]ƒ“‚Ģ–šŠ„‚ĶŲ–¾‚³‚ź‚Ä‚¢‚Č‚¢iØCQ6 ŽQĘjB

’jƒfƒLƒTƒƒ^ƒ]ƒ“i’ŽĖ–ņj‚Ģ“Š—^—Ź•\Ž¦‚É‚Ā‚¢‚Ä‚Ķu§“f–ņŽ”—Ć‚Ģƒ_ƒCƒAƒOƒ‰ƒ€’Žßv‚šŽQĘ‚³‚ź‚½‚¢B

+ ŽQl‚É‚µ‚½“ńŽŸŽ‘—æ
  1. NCCN Clinical Practice Guidelines in Oncology-Antiemesis-ver. 2, 2017
  2. MASCC/ESMO Antiemetic Guidelines 2016
  3. Hesketh PJ, Kris MG, Basch E, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017; 35: 3240-61.
  4. Naeim A, Dy SM, Lorenz KA, et al. Evidence-based recommendations for cancer nausea and vomiting. J Clin Oncol. 2008; 26: 3903-10.
  5. Hesketh PJ. Chemotherapy-induced nausea and vomiting. N Engl J Med. 2008; 358: 2482-94.
ŽQl•¶Œ£
i jƒGƒrƒfƒ“ƒXƒŒƒxƒ‹

1j Aapro MS, Alberts DS. High-dose dexamethasone for prevention of cis-platin-induced vomiting. Cancer Chemother Pharmacol. 1981; 7: 11-4.

iⅡ j

2j Ioannidis JP, Hesketh PJ, Lau J. Contribution of dexamethasone to control of chemotherapy-induced nausea and vomiting: a meta-analysis of randomized evidence. J Clin Oncol. 2000; 18: 3409-22.

iⅠ j

3j Grunberg SM. Antiemetic activity of corticosteroids in patients receiving cancer chemotherapy: dosing, efficacy, and tolerability analysis. Ann Oncol. 2007; 18: 233-40.

iⅠ j

4j Sekine I, Nishiwaki Y, Kakinuma R, et al. Phase‡U study of high-dose dexamethasone-based association in acute and delayed high-dose cisplatin-induced emesis--JCOG study 9413. Br J Cancer. 1997; 76: 90-2.

iIIIj

5j Nakade S, Ohno T, Kitagawa J, et al. Population pharmacokinetics of aprepitant and dexamethasone in the prevention of chemotherapy-induced nausea and vomiting. Cancer Chemother Pharmacol. 2008; 63: 75-83.

iⅣ j

6j Aapro M, Fabi A, Nolè F, et al. Double-blind, randomised, controlled study of the efficacy and tolerability of palonosetron plus dexamethasone for 1 day with or without dexamethasone on days 2 and 3 in the prevention of nausea and vomiting induced by moderately emetogenic chemotherapy. Ann Oncol. 2010; 21: 1083-8.

iⅡ j

7j Celio L, Frustaci S, Denaro A, et al. Palonosetron in combination with 1-day versus 3-day dexamethasone for prevention of nausea and vomiting following moderately emetogenic chemotherapy: a randomized, multicenter, phase III trial. Support Care Cancer. 2011; 19: 1217-25.

iⅡ j

8j Komatsu Y, Okita K, Yuki S, et al. Open-label, randomized, comparative, phase III study on effects of reducing steroid use in combination with Palonosetron. Cancer Sci. 2015; 106: 891-5.

iⅡ j


Clinical QuestionE„§ˆź——‚Ö


CQ6
“Ėo«ˆ«SEšq“f‚š‚Ē‚Ģ‚ꂤ‚ÉŽ”—Ć‚·‚é‚©

„§ƒOƒŒ[ƒh

B ģ—p‹@˜‚ĢˆŁ‚Ȃ鐧“f–ņ‚š•””C’莞“Š—^‚·‚éB‚Ü‚½C5-HT3Žó—e‘ĢhR–ņ‚š—\–h‚ÉŽg—p‚µ‚½ź‡C—\–h‚É—p‚¢‚½‚ą‚Ģ‚ĘˆŁ‚Č‚é5-HT3Žó—e‘ĢhR–ņ‚É•ĻX‚·‚éB

kØ§“f—Ć–@ƒAƒ‹ƒSƒŠƒYƒ€③ ŽQĘl

+ ”wŒiE–Ś“I

§“f–ņ‚Ģ—\–h“I“Š—^‚š\•Ŗs‚Į‚Ä‚ąˆ«SEšq“f‚Ŗ”­Œ»EŒp‘±‚·‚鏼‡‚š“Ėo«ˆ«SEšq“fibreakthrough nausea and vomitingj‚Ę’č‹`‚·‚éB“Ėo«ˆ«SEšq“f‚ĢŽ”—Ć‚Ķ¢“ļ‚Å‚ ‚邽‚߁C‚Ŗ‚ń–ņ•Ø—Ć–@‚Ģ‰‰ńŽ{sŽž‚É‚Ø‚¢‚Ä‚Ķˆ«SEšq“f—\–h‚š\•Ŗ‚ɍs‚¤B‚Ü‚½ˆ«SEšq“f‚Ŗ‘±‚­ź‡‚É‚ĶC‚Ŗ‚ń–ņ•Ø—Ć–@‚É‚ę‚鈫SEšq“f‚©C‚»‚źˆČŠO‚Ģ•a‘Ō‚É‚ę‚é‚ą‚Ģ‚©‚šŠÓ•Ź‚·‚é•K—v‚Ŗ‚ ‚éiØCQ15 ŽQĘjB

+ ‰šą

ˆź”ŹŒ“‘„‚Ķģ—p‹@˜‚ĢˆŁ‚Č‚é‚»‚Ģ‘¼‚Ģ§“f–ņ‚š’Ē‰Į“Š—^‚·‚邱‚Ę‚Å‚ ‚éB—\–h“I“Š—^‚ÅŽg—p‚³‚ź‚邱‚Ę‚Ģ‘½‚¢5-HT3Žó—e‘ĢhR–ņˆČŠO‚ň«SEšq“f‚š‰ü‘P‚³‚¹‚é–ņ•Ø‚Ę‚µ‚āCƒhƒpƒ~ƒ“Žó—e‘ĢhR–ņiƒƒgƒNƒƒvƒ‰ƒ~ƒhCƒnƒƒyƒŠƒh[ƒ‹jC•›t”ēŽæƒXƒeƒƒCƒhCƒxƒ“ƒ]ƒWƒAƒ[ƒsƒ“ŒnR•sˆĄ–ņiƒƒ‰ƒ[ƒpƒ€CƒAƒ‹ƒvƒ‰ƒ]ƒ‰ƒ€j‚Č‚Ē‚Ŗ•ń‚³‚ź‚Ä‚¢‚éBis‚Ŗ‚ńŠ³ŽŅ‚ɂ؂Ƃ鈫SEšq“f‚É‘Ī‚·‚鐧“f–ņ‚ĢƒVƒXƒeƒ}ƒeƒBƒbƒNEƒŒƒrƒ…[‚Å‚ĶCƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚É‚Ø‚¢‚ăƒgƒNƒƒvƒ‰ƒ~ƒh‚Ŗƒvƒ‰ƒZƒ{‚ę‚č‚ą—D‚ź‚Ä‚Ø‚čC5-HT3Žó—e‘ĢhR–ņ‚Å‚ ‚éƒIƒ“ƒ_ƒ“ƒZƒgƒƒ“‚ĘƒƒgƒNƒƒvƒ‰ƒ~ƒh‚Ķ“Æ“™‚ĢŒų‰Ź‚Å‚ ‚Į‚½B‚µ‚©‚µC‘tŒų—¦‚Ķˆ«S‚É‘Ī‚µ23`36“Cšq“f‚É‘Ī‚µ18`52“‚Ę‚¢‚ø‚ź‚ą’į—¦‚Å‚ ‚Į‚½1jB‚“x‚Ü‚½‚Ķ’†“™“xƒŠƒXƒN‚Ģ–ņ•Ø—Ć–@‚šŽ{s‚µ‚½i96 –¼jŒć‚Ɉ«SEšq“f‚š‚«‚½‚µ‚½39 –¼‚š‘ĪŪ‚ɍs‚Į‚½C“Ėo«ˆ«SEšq“f‚É‘Ī‚·‚é‘OŒü‚«‚ĢƒpƒCƒƒbƒgŽŽŒ±‚Å‚ĶCƒvƒƒNƒƒ‹ƒyƒ‰ƒWƒ“‚šŽg—p‚µ‚½24 –¼‚Ģƒf[ƒ^‚šŒŸ“¢‚µ‚½Œ‹‰ŹC“Š—^4 ŽžŠŌŒć‚Ģˆ«SƒXƒRƒA‚Ķ•½‹Ļ75“Œø­‚µ‚½2jB‚Ü‚½C‚“xƒŠƒXƒN‚Ģ–ņ•Ø—Ć–@‚šŽ{s‚µ‚½Œć‚É“Ėo«ˆ«SEšq“f‚š‚«‚½‚µ‚½Š³ŽŅ‚š‘ĪŪ‚ɁCƒIƒ‰ƒ“ƒUƒsƒ“i10 mg 1 “ś1 ‰ń3 “śŠŌj‚Ü‚½‚ĶƒƒgƒNƒƒvƒ‰ƒ~ƒhi10 mg 1 “ś3 ‰ń3 “śŠŌj‚š“Š—^‚µ‚½“ńd–ÓŒŸƒ‰ƒ“ƒ_ƒ€‰»ŽŽŒ±‚Å‚ĶC72 ŽžŠŌ‚ĢŠĻŽ@ŠśŠŌ’†‚ɃIƒ‰ƒ“ƒUƒsƒ“ŒQ‚Ŗ—LˆÓ‚Ɉ«SEšq“f‚š—}§‚µ‚½3jB‚Ü‚½CƒIƒ‰ƒ“ƒUƒsƒ“‚ĢCINV ‚É‘Ī‚·‚éƒVƒXƒeƒ}ƒeƒBƒbƒNEƒŒƒrƒ…[‚Å‚ĶC“Ėo«ˆ«SEšq“f‚É‘Ī‚µ‚Ä‚Ģ—LŒų«‚ŖŽ¦‚³‚ź‚Ä‚¢‚é4jBNCCN ƒKƒCƒhƒ‰ƒCƒ“2017 ‚āASCO ƒKƒCƒhƒ‰ƒCƒ“2017 ‚Å‚ĶƒIƒ‰ƒ“ƒUƒsƒ“‚Ŗ—\–h“Š—^‚³‚ź‚Ä‚¢‚Č‚Æ‚ź‚ĪŽg—p‚šŒŸ“¢‚·‚邱‚ʁC‚·‚Å‚ÉŽg—p‚µ‚Ä‚¢‚ź‚Ī‚»‚Ģ‘¼‚Ģģ—p‹@˜‚ŖˆŁ‚Č‚é–ņÜ‚š•””•¹—p‚·‚邱‚ʁC‚Ü‚½•K—vŽž“Š—^‚Å‚Ķ‚Č‚­’莞“Š—^‚šs‚¤‚±‚Ę‚ŖŠ©‚ß‚ē‚ź‚Ä‚¢‚éB

5-HT3Žó—e‘ĢhR–ņ‚É‚Ā‚¢‚Ä‚ĶC—\–h‚É—p‚¢‚½‚ą‚Ģ‚ĘˆŁ‚Č‚é5-HT3Žó—e‘ĢhR–ņ‚šŽg—p‚·‚é•ń‚Ŗ‚ ‚éB‚“xƒŠƒXƒN‚Ģ–ņ•Ø—Ć–@‚šs‚¢CƒIƒ“ƒ_ƒ“ƒZƒgƒƒ“8 mgiĆ’j‚ĘƒfƒLƒTƒƒ^ƒ]ƒ“10 mgiĆ’j‚šŽg—p‚µ‚½Œć‚Ɉ«SEšq“f‚š‚«‚½‚µ‚½Š³ŽŅ‚š‘ĪŪ‚ɁC‚»‚Ģ‚Ü‚ÜŽ”—Ć‚š‘±‚Æ‚éŒQ‚ĘƒOƒ‰ƒjƒZƒgƒƒ“3 mgiĆ’j‚ĘƒfƒLƒTƒƒ^ƒ]ƒ“10 mgiĆ’j‚É•ĻX‚·‚éŒQ‚Å“ńd–ÓŒŸƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚šs‚Į‚½•ń‚Å‚ĶCˆ«SEšq“f‚ĢŠ®‘S§ŒäŠ„‡‚š‚Ż‚é‚ĘƒOƒ‰ƒjƒZƒgƒƒ“‚É•ĻX‚µ‚½ŒQ‚Å—LˆÓ‚ɍ‚‚©‚Į‚½i5“ vs. 47“j5jB‘ę2 ¢‘ć‚Ģ5-HT3 Žó—e‘ĢhR–ņ‚Å‚ ‚éƒpƒƒmƒZƒgƒƒ“‚ĶC‹}«šq“f‚Ģ—\–h‚¾‚Æ‚Å‚Č‚­’x”­«šq“f‚Ģ—\–h‚É‚ą—LŒų‚Å‚ ‚邱‚Ę‚Ŗ•ń‚³‚ź‚Ä‚¢‚éi’x”­Šśšq“fŠ®‘S§ŒäŠ„‡: ƒOƒ‰ƒjƒZƒgƒƒ“ŒQ44.5“ vs. ƒpƒƒmƒZƒgƒƒ“ŒQ56.8“j6jB•””“ś‚É‚ķ‚½‚čR‚Ŗ‚ń–ņ‚š“Š—^‚·‚銳ŽŅ‚š‘ĪŪ‚ɁCƒpƒƒmƒZƒgƒƒ“0.25 mgiĆ’j‚ĘƒfƒLƒTƒƒ^ƒ]ƒ“8 mgiĆ’j•¹—p‚ň«SEšq“f‚Ģ—\–h‚šs‚Į‚½Œć‚É“Ėo«ˆ«SEšq“f‚š‚«‚½‚µ‚½Ē—į‚É‘Ī‚µ‚āCƒpƒƒmƒZƒgƒƒ“‚š72 ŽžŠŌŒć‚É“Š—^‚µ‚½ź‡‚Ģ¬Ń‚ʁCƒIƒ“ƒ_ƒ“ƒZƒgƒƒ“8 mgiĆ’j‚ĘƒfƒLƒTƒƒ^ƒ]ƒ“8 mgiĆ’j•¹—p‚Ģź‡‚Å‚Ģ¬Ńk“Ėo«ˆ«SEšq“f‚š‚«‚½‚µ‚½Ē—į‚É‘Ī‚µ‚Ä‚ĶƒƒgƒNƒƒvƒ‰ƒ~ƒh20 mgiĆ’j‚šŽg—pl‚šƒqƒXƒgƒŠƒJƒ‹ƒRƒ“ƒgƒ[ƒ‹‚Ę‚µ‚Ä”äŠr‚µ‚½B‚±‚ĢŒ‹‰ŹCƒpƒƒmƒZƒgƒƒ““Š—^ŒQ‚Å‚Ķ’Ē‰Į“Š—^‚Å‹~Ļ‚Å‚«‚½Ē—į‚Ŗ67“‚Å‚ ‚é‚Ģ‚É‘Ī‚µCƒqƒXƒgƒŠƒJƒ‹ƒRƒ“ƒgƒ[ƒ‹‚Å‚Ķ22“‚Å‚ ‚Į‚½ip0.04j7jB‚½‚¾‚µCƒpƒƒmƒZƒgƒƒ“‚ÉŠÖ‚·‚邱‚ĢŒ¤‹†‚ĶCƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚ĢŒ‹‰Ź‚Å‚Ķ‚Č‚¢‚½‚߁C”Œć‚ĢƒGƒrƒfƒ“ƒX‚š‚Ż‚Č‚Ŗ‚ēŒŸ“¢‚·‚ׂ«‚Å‚ ‚éB

ŽŸ‰ń‚Ģ‚Ŗ‚ń–ņ•Ø—Ć–@Ž{s‘O‚É‚ĶCˆ«SEšq“f‚Ģ—\–h“I“Š—^‚Ŗ–³Œų‚Ü‚½‚Ķ•s\•Ŗ‚Å‚ ‚Į‚½‚»‚ĢŒ“ˆö‚É‚Ā‚¢‚ďŚ×ŒŸ“¢‚šs‚¤B‚»‚ĢŪCˆ«SEšq“f‚ĢŒ“ˆö‚Ŗ‚Ŗ‚ń–ņ•Ø—Ć–@ˆČŠOiØCQ15 ŽQĘj‚Č‚Ģ‚©”Ū‚©‚šŠm”F‚·‚éBŽŸ‰ń‚ĢR‚Ŗ‚ń–ņ‚šŽg—p‚·‚éŪ‚ĶC‚ę‚č‚‚¢Ć“f«ƒŠƒXƒN‚ɏ€‚¶‚Ä—\–h“Š—^‚šs‚¤B‚Ŗ‚ń–ņ•Ø—Ć–@‚Ģ–Ś“I‚ŖĒóŠÉ˜a‚Å‚ ‚鏼‡‚ĶCŽŸ‰ń‚ĢR‚Ŗ‚ń–ņ‚ĶŒø—Ź‚·‚é‚©Ć“f«ƒŠƒXƒN‚Ģ’į‚¢R‚Ŗ‚ń–ņ‚Ö‚Ģ•ĻX‚šl‚¦‚éB

+ ŽQl‚É‚µ‚½“ńŽŸŽ‘—æ
  1. NCCN Clinical Practice Guidelines in Oncology-Antiemesis-ver. 2, 2017
  2. Hesketh PJ, Kris MG, Basch E, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017; 35: 3240-61.
  3. 2017 UpToDate Version 78.0gPrevention and treatment of chemotherapy-induced nausea and vomiting in adultsh
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i jƒGƒrƒfƒ“ƒXƒŒƒxƒ‹

1j Glare P, Pereira G, Kristjanson LJ, et al. Systematic review of the efficacy of antiemetics in the treatment of nausea in patients with far-advanced cancer. Support Care Cancer. 2004; 12: 432-40.

iⅠ j

2j Jones JM, Qin R, Bardia A, et al. Antiemetics for chemotherapy-induced nausea and vomiting occurring despite prophylactic antiemetic therapy. J Palliat Med. 2011; 14: 810-4

iIIIj

3j Navari RM, Nagy CK, Gray SE. The use of olanzapine versus metoclopramide for the treatment of breakthrough chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy. Support Care Cancer. 2013; 21: 1655-63.

iⅡ j

4j Chiu L, Chow R, Popovic M et al.Efficacy of olanzapine for the prophylaxis and rescue of chemotherapy-induced nausea and vomiting (CINV): a systematic review and meta-analysis.. Support Care Cancer. 2016; 24: 2381-92.

iⅠ j

5j de Wit R, de Boer AC, vd Linden GH, et al. Effective cross-over to granisetron after failure to ondansetron, a randomized double blind study in patients failing ondansetron plus dexamethasone during the first 24 hours following highly emetogenic chemotherapy. Br J Cancer. 2001; 85: 1099-101.

iⅡ j

6j Saito M, Aogi K, Sekine I, et al. Palonosetron plus dexamethasone versus granisetron plus dexamethasone for prevention of nausea and vomiting during chemotherapy: a double-blind, double-dummy, randomised, comparative phase III trial. Lancet Oncol. 2009; 10: 115-24.

iⅡ j

7j Musso M, Scalone R, Bonanno V, et al. Palonosetroni Aloxij and dexamethasone for the prevention of acute and delayed nausea and vomiting in patients receiving multiple-day chemotherapy. Support Care Cancer. 2009; 17: 205-9.

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Clinical QuestionE„§ˆź——‚Ö


CQ7
Œy“x‚ą‚µ‚­‚ĶÅ¬“xƒŠƒXƒN‚ĢR‚Ŗ‚ń–ņ‚Ő¶‚¶‚½‹}«‚Ģˆ«SEšq“f‚š
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C2 Å¬“xƒŠƒXƒNR‚Ŗ‚ń–ņ‚Ģź‡‚ĶCƒfƒLƒTƒƒ^ƒ]ƒ“‚Ģƒ‹[ƒ`ƒ“Žg—p‚Ķ„§‚³‚ź‚Č‚¢B
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+ ‰šą

Œy“xƒŠƒXƒNR‚Ŗ‚ń–ņ‚Ģ‹}«ˆ«SEšq“f‚É‘Ī‚µ‚Ä‚ĶCƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚Ķs‚ķ‚ź‚Ä‚¢‚Č‚¢B‚“xE’†“™“xƒŠƒXƒN‚ĢR‚Ŗ‚ń–ņ‚É‘Ī‚·‚鐧“fŒų‰Ź‚©‚ē„‘Ŗ‚µ‚½Œ‹‰ŹCŒy“xƒŠƒXƒNR‚Ŗ‚ń–ņ‚É‚ę‚é‹}«‚Ģˆ«SEšq“f‚Ģ—\–hŽ”—Ć‚Ę‚µ‚āCASCO ƒKƒCƒhƒ‰ƒCƒ“2017CMASCC/ESMO ƒKƒCƒhƒ‰ƒCƒ“2016 ‚Å‚ĶƒfƒLƒTƒƒ^ƒ]ƒ“4`8 mg ’P“Ę“Š—^‚Ŗ„§‚³‚ź‚Ä‚¢‚é1j2jB‚Ü‚½CƒvƒƒNƒƒ‹ƒyƒ‰ƒWƒ“3j‚ ‚é‚¢‚ĶƒƒgƒNƒƒvƒ‰ƒ~ƒh‚ąƒIƒvƒVƒ‡ƒ“‚Ģˆź‚Ā‚Å‚ ‚éiØ§“f–ņˆź——ŽQĘjBÅ¬“xƒŠƒXƒNR‚Ŗ‚ń–ņ‚É‘Ī‚µ‚Ä‚Ķ§“f–ņ‚Ģ—\–h“Š—^‚Ķ„§‚³‚ź‚Č‚¢B•K—v‚ɉž‚¶‚ÄŒy“xƒŠƒXƒNR‚Ŗ‚ń–ņ‚ɏ€‚¶‚½‘Ī‰ž‚šl‚¦‚é‚ׂ«‚Å‚ ‚ė‚¤iØ§“f–ņŽ”—Ć‚Ģƒ_ƒCƒAƒOƒ‰ƒ€③ ŽQĘjB

+ ŽQl‚É‚µ‚½“ńŽŸŽ‘—æ
  1. NCCN Clinical Practice Guidelines in Oncology-Antiemesis-ver. 2, 2017
  2. Berger MJ, Ettinger DS, Aston J, et al. NCCN Guidelines Insights: Antiemesis, Version 2.2017. J Natl Compr Canc Netw. 2017; 15: 883-893.
  3. MASCC/ESMO Antiemetic Guidelines 2016
  4. Hesketh PJ, Kris MG, Basch E, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017; 35: 3240-61.
  5. “ś–{“ūŠąŠw‰ļ•ŅD‰ČŠw“IŖ‹’‚ÉŠī‚Ć‚­“ūŠąf—ĆƒKƒCƒhƒ‰ƒCƒ“ ① Ž”—Ć•Ņ2015 ”N”ŁC ‹ąŒ“o”ŁC“Œ‹žC2015D
  6. Hesketh PJ. Chemotherapy-induced nausea and vomiting. N Engl J Med. 2008; 358: 2482-94.
  7. Naeim A, Dy SM, Lorenz KA, et al. Evidence-based recommendations for cancer nausea and vomiting. J Clin Oncol. 2008; 26: 3903-10.
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i jƒGƒrƒfƒ“ƒXƒŒƒxƒ‹

1j Warr D, Oliver T, and members of the Systemic Treatment Disease Site Group. The Role of Neurokinin-1 Receptor Antagonists in the Prevention of Emesis due to High-dose Cisplatin. Cancer Care Ontario. 2005.
https: //www.cancercare.on.ca/common/pages/UserFile.aspx?serverId=6&path=/File%20Database/CCO%20Files/PEBC/pebc12-4f.pdf

iⅠ j

2j Ioannidis JP, Hesketh PJ, Lau J. Contribution of dexamethasone to control of chemotherapy- induced nausea and vomiting: a meta-analysis of randomized evidence. J Clin Oncol. 2000; 18: 3409-22.

iⅠ j

3j Ettinger DS, Bierman PJ, Bradbury B, et al. Antiemesis. J Natl Compr Canc Netw. 2007; 5: 12-33.

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Clinical QuestionE„§ˆź——‚Ö


CQ8
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ƒVƒXƒvƒ‰ƒ`ƒ“‚Ķ‘½‚­‚Ģ‚Ŗ‚ńŽķ‚É‚Ø‚¢‚āC3`4 TŠŌ–ˆ‚ĢŠŌŒ‡“Š—^–@i†50 mg/m2j‚Ŗ‘½—p‚³‚ź‚éB‚Ü‚½C”ńƒzƒWƒLƒ“ƒŠƒ“ƒpŽī‚āćó×–EŽīį‡‚Å‚Ķ•ŖŠ„˜A‘±“Š—^–@i100 mg/m2 ‚š4`5 “śŠŌj‚ŖƒGƒrƒfƒ“ƒX‚Ę‚µ‚ÄŠm—§‚³‚ź‚Ä‚¢‚éBƒVƒXƒvƒ‰ƒ`ƒ“‚ĶĆ“fģ—p‚Ŗ‹­‚¢–ņÜ‚Å‚ ‚邽‚߁C•ŖŠ„“Š—^‚Ģź‡‚Å‚ąŠŌŒ‡“Š—^–@‚Ģź‡‚Ę“Æ—l‚Ģ§“f—Ć–@‚Ŗ•K—v‚Å‚ ‚é‚ʐ„‘Ŗ‚³‚ź‚éB

+ ‰šą

ƒVƒXƒvƒ‰ƒ`ƒ“‚Ķ‘½‚­‚Ģ‚Ŗ‚ńŽķ‚É‚Ø‚¢‚āC3`4 TŠŌ–ˆ‚ÉŠŌŒ‡“Š—^i†50 mg/m2j‚³‚ź‚鏼‡‚Ŗ‘½‚¢‚ŖC‚¢‚­‚Ā‚©‚Ģ‚Ŗ‚ńŽķ‚É‚Ø‚¢‚Ä‚ĶCƒVƒXƒvƒ‰ƒ`ƒ“iƒ50 mg/m2j‚Ģ•ŖŠ„ŠŌŒ‡“Š—^‚ą‚µ‚­‚Ķ•ŖŠ„˜A‘±“Š—^‚ĢƒGƒrƒfƒ“ƒX‚ŖŠm—§‚³‚ź‚Ä‚¢‚éB‚»‚ź‚ē‚Ģ‘ć•\“I‚Č‚Ŗ‚ńŽķ‚Ę‚µ‚āC’_“¹‚Ŗ‚ń‚ā”ńƒzƒWƒLƒ“ƒŠƒ“ƒpŽīCćó×–EŽī‚Ŗ‚ ‚é1j2jBASCO ƒKƒCƒhƒ‰ƒCƒ“2017CMASCC/ESMO ƒKƒCƒhƒ‰ƒCƒ“2016 , NCCNƒKƒCƒhƒ‰ƒCƒ“2017 ‚Å‚ĶCƒVƒXƒvƒ‰ƒ`ƒ“‚Ķ—p—Ź‚ÉŠÖŒW‚Č‚­C‚“xƒŠƒXƒN‚É•Ŗ—Ž‚³‚ź‚Ä‚¢‚éB

ASCOCMASCC/ESMOCNCCN ƒKƒCƒhƒ‰ƒCƒ“‚Å‚ĶC‚“x‚Ø‚ę‚Ńˆź•”‚Ģ’†“™“xƒŠƒXƒNR‚Ŗ‚ń–ņ‚š“Š—^‚·‚銳ŽŅ‚É‘Ī‚µ‚āCNK1Žó—e‘ĢhR–ņ‚Å‚ ‚éƒAƒvƒŒƒsƒ^ƒ“ƒg‚Ø‚ę‚ŃƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒg‚ĢŽg—p‚Ŗ„§‚³‚ź‚Ä‚¢‚éBƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚É‚Ø‚¢‚ăAƒvƒŒƒsƒ^ƒ“ƒg‚Ø‚ę‚ŃƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒg•¹—p‚ĢŽå‚½‚éƒGƒrƒfƒ“ƒX‚Ŗ‚ ‚é‚Ģ‚ĶCƒVƒXƒvƒ‰ƒ`ƒ“†70 mg/m2‚Ģź‡‚Å‚ ‚č3j`6jC’į—p—ŹƒVƒXƒvƒ‰ƒ`ƒ“‚ĢƒGƒrƒfƒ“ƒX‚ĶCćó×–EŽī‚š‘ĪŪ‚É5 “śŠŌ˜A‘±’į—p—ŹƒVƒXƒvƒ‰ƒ`ƒ““Š—^Žž‚ĢƒAƒvƒŒƒsƒ^ƒ“ƒg‚Ģćę‚¹Œų‰Ź‚šŒŸŲ‚µ‚½¬‹K–Ķ‚Ģ‘ęIII‘Šƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±7jCŽq‹{čņ‚Ŗ‚ń‚š‘ĪŪ‚ɉ»Šw•śŽĖüŽžiƒVƒXƒvƒ‰ƒ`ƒ“ 40mg/m2–ˆT“Š—^j‚ɃzƒXƒAƒvƒŒƒsƒ^ƒ“ƒg‚Ģćę‚¹Œų‰Ź‚šŒŸŲ‚µ‚½‘ęIII‘Šƒ‰ƒ“ƒ_ƒ€‰»ŽŽŒ±8j‚Ę‹Ķ‚©‚Å‚ ‚éBˆź•ūCƒIƒ‰ƒ“ƒUƒsƒ“‚ĶCƒVƒXƒvƒ‰ƒ`ƒ“‚ą‚µ‚­‚ĶAC —Ć–@‚É‘Ī‚µCƒpƒƒmƒZƒgƒƒ“‚ĘƒfƒLƒTƒƒ^ƒ]ƒ“‚Ģ2Ü•¹—p‰ŗ‚ɁCƒAƒvƒŒƒsƒ^ƒ“ƒg‚Ę‚Ģ—LˆÓ‚ȍ·‚Ŗ‚Č‚­9jCƒfƒLƒTƒƒ^ƒ]ƒ“‚Ę5HT3Žó—e‘ĢhR–ņ‹y‚ŃƒAƒvƒŒƒsƒ^ƒ“ƒg‚Ģ3 Ü•¹—p‰ŗ‚ɁCƒvƒ‰ƒZƒ{‚É‘Ī‚·‚é—D‰z«‚ŖŽ¦‚³‚ź‚½10jB—¼ŽŽŒ±‚ĶƒVƒXƒvƒ‰ƒ`ƒ“†70 mg/m2‚š‘ĪŪ‚Ę‚µ‚Ä‚¢‚邽‚߁C’į—p—Ź‚ĢƒVƒXƒvƒ‰ƒ`ƒ“‚É‘Ī‚·‚éƒIƒ‰ƒ“ƒUƒsƒ“‚ĢƒGƒrƒfƒ“ƒX‚Ķ–R‚µ‚¢B’į—p—ŹƒVƒXƒvƒ‰ƒ`ƒ“‚šŽg—p‚·‚é‚»‚Ģ‘¼‚Ģ‚Ŗ‚ńŽķi’_“¹‚Ŗ‚ń“™j‚É‘Ī‚µ‚Ä‚ĶCŠ³ŽŅ‚ĢQOL ‚ÉŠÓ‚Ż“KŲ‚Č‘Ī‰ž‚Ŗ•K—v‚Å‚ ‚éB

+ ŽQl‚É‚µ‚½“ńŽŸŽ‘—æ
  1. NCCN Clinical Practice Guidelines in Oncology-Antiemesis-ver. 2, 2017
  2. MASCC/ESMO Antiemetic Guidelines 2016
  3. Hesketh PJ, Kris MG, Basch E, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017; 35: 3240-61.
ŽQl•¶Œ£
i jƒGƒrƒfƒ“ƒXƒŒƒxƒ‹

1j Valle J, Wasan H, Palmer DH, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010; 362: 1273-81.

iⅡ j

2j Williams SD, Birch R, Einhorn LH, et al. Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide. N Engl J Med. 1987; 316: 1435-40.

 

3j Poli-Bigelli S, Rodrigues-Pereira J, Carides AD, et al. Addition of the neurokinin 1 receptor antagonist aprepitant to standard antiemetic therapy improves control of chemotherapy-induced nausea and vomiting. Results from a randomized, double-blind, placebo-controlled trial in Latin America. Cancer. 2003; 97: 3090-8.

iⅡ j

4j Hesketh PJ, Grunberg SM, Gralla RJ, 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: 4112-9.

iⅡ j

5j Saito H, Yoshizawa H, Yoshimori K, et al. Efficacy and safety of single-dose fosaprepitant in the prevention of chemotherapy-induced nausea and vomiting in patients receiving high-dose cisplatin: a multicentre, randomised, double-blind, placebo-controlled phase 3 trial. Ann Oncol. 2013; 24: 1067-73.

iⅡ j

6j Grunberg S, Chua D, Maru A, et al. Single-dose fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting associated with cisplatin therapy: randomized, double-blind study protocol--EASE. J Clin Oncol. 2011; 29: 1495-501.

iⅡ j

7j Albany C, Brames MJ, Fausel C, et al. Randomized, double-blind, placebo-controlled, phase III cross-over study evaluating the oral neurokinin-1 antagonist aprepitant in combination with a 5HT3 receptor antagonist and dexamethasone in patients with germ cell tumors receiving 5-day cisplatin combination chemotherapy regimens: a hoosier oncology group study. J Clin Oncol. 2012; 30: 3998-4003.

iⅡ j

8j Ruhlmann CH, Christensen TB, Dohn LH, et al. Efficacy and safety of fosaprepitant for the prevention of nausea and emesis during 5 weeks of chemoradiotherapy for cervical cancer (the GAND-emesis study): a multinational, randomised, placebo-controlled, double-blind, phase 3 trial. Lancet Oncol. 2016; 17: 509-18.

9j Navari RM, Gray SE, Kerr AC. Olanzapine versus aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a randomized phase ‡V trial. J Support Oncol. 2011; 9: 188-95.

iⅡ j

10j Navari RM, Qin R, Ruddy KJ, et al. Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting. N Engl J Med 2016; 375: 134-42.


Clinical QuestionE„§ˆź——‚Ö


CQ9
—\Šś«ˆ«SEšq“f‚š‚Ē‚Ģ‚ꂤ‚É—\–h‚µŽ”—Ć‚·‚é‚©

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B —\Šś«ˆ«SEšq“f‚É‘Ī‚·‚éÅ‘P‚Ģ‘Īō‚ĶC‚Ŗ‚ń–ņ•Ø—Ć–@Ž{sŽž‚Ģ‹}«‚Ø‚ę‚Ń’x”­«šq“f‚ĢŠ®‘S§Œä‚Å‚ ‚čCŠ³ŽŅ‚Ɉ«SEšq“f‚šŒoŒ±‚³‚¹‚Č‚¢‚±‚Ę‚Å‚ ‚éB
B —\Šś«ˆ«SEšq“f‚É‘Ī‚µ‚āCƒxƒ“ƒ]ƒWƒAƒ[ƒsƒ“ŒnR•sˆĄ–ņ‚Ŗ—LŒų‚Å‚ ‚éB
B —\Šś«ˆ«SEšq“f‚É‘Ī‚µ‚āCS—Šw“IŽ”—Ć–@‚Ŗ—LŒų‚Å‚ ‚éB
  • Œn““I’EŠ“ģCƒŠƒ‰ƒNƒZ[ƒVƒ‡ƒ“CĆ–°/ƒCƒ[ƒW“±“ü–@

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+ ”wŒiE–Ś“I

‚Ŗ‚ń–ņ•Ø—Ć–@‚ā•śŽĖü—Ć–@‚šŽó‚Æ‚½‚Ę‚«‚Ɉ«SEšq“f‚šŒoŒ±‚µ‚½Š³ŽŅ‚Å‚ĶCŽŸ‰ń‚Ģ‚Ŗ‚ń–ņ•Ø—Ć–@‚ā•śŽĖü—Ć–@‚šŽó‚Æ‚é‘O‚©‚ēCˆ«S‚āšq“f‚Ŗ¶‚¶‚邱‚Ę‚Ŗ‚ ‚čC‚±‚ź‚šu—\Šś«ˆ«SEšq“fianticipatory nausea and vomitingjv‚Ę‚¢‚¤B

+ ‰šą

—\Šś«ˆ«SEšq“f‚Ę‚ĶC‚Ŗ‚ń–ņ•Ø—Ć–@‚ā•śŽĖü—Ć–@‚šŽó‚ƂĈ«SEšq“f‚š‚Š‚Ę‚½‚ŃŒoŒ±‚µ‚½Š³ŽŅ‚É‚Ø‚¢‚āCušŒ‚Ć‚Æv‚Ģ‹@˜‚Ŗģ—p‚µ‚Ä”­¶‚·‚錻Ū‚š‚¢‚¤1j`3jB

—į‚¦‚ĪC‚Ŗ‚ń–ņ•Ø—Ć–@‚šŽó‚Æ‚½Œć‚Ɉ«S‚āšq“f‚šŒJ‚č•Ō‚µŒoŒ±‚·‚邤‚æ‚ɁCŽĄŪ‚ĢR‚Ŗ‚ń–ņ“Š—^‚ŖŽn‚Ü‚é‘O‚©‚ēi‚Ŗ‚ń–ņ•Ø—Ć–@‚Ģ‘O“ś‚ā“–“ś’©C•a‰@‚É’…‚¢‚Ä‚©‚ē“™jC‚Ŗ‚ń–ņ•Ø—Ć–@‚Ģ‚±‚Ę‚šl‚¦‚½‚č•a‰@‚É—ˆ‚½‚肵‚½‚¾‚ƂŁCˆ«S‚šĆ‚µ‚½‚čšq“f‚µ‚½‚č‚·‚é‚ꂤ‚É‚Č‚éź‡‚šŽw‚µ‚Ä‚¢‚éB

—\Šś«ˆ«SEšq“f‚Ģ•p“x‚ĶC‚©‚Ā‚Ä20“’ö“x‚Ü‚Å‚ ‚é‚Ę‚Ģ’²øŒ‹‰Ź‚Å‚ ‚Į‚½‚ŖC‹ß”N‚Ģ§“f—Ć–@‚Ģi•ą‚ÅŒø­‚µC—\Šś«ˆ«S‚Ŗ13.8“ˆČ‰ŗ6j7jC—\Šś«šq“f‚Ķ2.3“ˆČ‰ŗ6j‚Ę‚Č‚Į‚Ä‚¢‚éB‚Ŗ‚ń–ņ•Ø—Ć–@‚ĢƒTƒCƒNƒ‹‚Ŗ‘½‚­‚Č‚é‚Ł‚Ē—\Šś«ˆ«SEšq“f‚ĢƒŠƒXƒN‚Ķ‚‚Ü‚éB‚Ü‚½C‚Ŗ‚ń–ņ•Ø—Ć–@I—¹Œć‚ą—\Šś«ˆ«SEšq“f‚ĢĒó‚Ŗ’·ˆų‚­‚±‚Ę‚Ŗ‚ ‚éB—\Šś«ˆ«SEšq“f‚É‘Ī‚·‚éÅ‘P‚Ģ‘Īō‚ĶC‚Ŗ‚ń–ņ•Ø—Ć–@‚ā•śŽĖü—Ć–@‚ĢŪ‚ɁCÅ‰‚©‚ēˆ«SEšq“f‚š¶‚¶‚³‚¹‚Č‚¢‚±‚Ę‚Å‚ ‚é2j`5jB‚±‚Ģ‚½‚ß‚É‚ĶŒv‰ę‚µ‚Ä‚¢‚鎔—Ć‚ĢĆ“f«‚š“KŲ‚É•]‰æ‚µ‚Ä“IŠm‚Ȑ§“f—Ć–@‚šs‚¤‚±‚Ę‚Å‚ ‚éBŒv‰ę‚µ‚Ä‚¢‚鎔—Ć‚ĢĆ“f«ƒŠƒXƒN‚ę‚č‰ŗˆŹ‚Ģ•s“K³‚Ȑ§“f—Ć–@‚šs‚Į‚Ä‚Ķ‚Č‚ē‚Č‚¢B

NCCN ƒKƒCƒhƒ‰ƒCƒ“‚Å‚ĶC—\Šś«ˆ«Sšq“f‚Ģ—Uˆö‚ʂȂ肤‚é‹­‚¢“õ‚¢‚š”š‚Ƃ邱‚Ę‚š„§‚µ‚Ä‚¢‚éB

—\Šś«ˆ«SEšq“f‚É‘Ī‚µ‚ăxƒ“ƒ]ƒWƒAƒ[ƒsƒ“ŒnR•sˆĄ–ņ‚Ŗ—LŒų‚Å‚ ‚čCNCCN ƒKƒCƒhƒ‰ƒCƒ“2017CMASCC/ESMO ƒKƒCƒhƒ‰ƒCƒ“2016 ‚Å‚ą„§‚³‚ź‚Ä‚¢‚éB—\Šś«ˆ«SEšq“f‚Ģ—\–h‚Ƀƒ‰ƒ[ƒpƒ€‚Ŗ8jC—\Šś«ˆ«S‚Ģ—\–h‚ɃAƒ‹ƒvƒ‰ƒ]ƒ‰ƒ€‚Ŗ—LŒų‚Å‚ ‚é9j‚±‚Ę‚ŖŠm”F‚³‚ź‚Ä‚¢‚éB

ˆ•ū—į

  • ƒƒ‰ƒ[ƒpƒ€: 1 ‰ń0.5`1.5 mg ‚šŒoŒū“Š—^
  • ‚Ŗ‚ń–ņ•Ø—Ć–@‚Č‚¢‚µ•śŽĖü—Ć–@‚ĢŽĄŽ{‘O–éC‚Ø‚ę‚Ń“–“śŽ”—Ć‚Ģ1`2 ŽžŠŌ‘O‚É“Š—^‚·‚éB‚Č‚ØC•K—v‚ɉž‚¶‚Ä‘—Ź‰Āi1 “ś3 mg ‚܂ŁjB‚—īŽŅ‚Å‚Ķ’į—p—Źi1 ‰ń0.5 mgj‚©‚ēŠJŽn‚·‚邱‚ʁB‚½‚¾‚µCCINV ‚É‘Ī‚·‚éŒų”\EŒų‰Ź‚š—L‚µ‚Ä‚Ø‚ē‚ø•ŪŒÆ“K—pŠO‚Å‚ ‚éB

  • ƒAƒ‹ƒvƒ‰ƒ]ƒ‰ƒ€: 1 ‰ń0.4`0.8 mg ‚š1 “ś2`3 ‰ńŒoŒū“Š—^
  • ‚Ŗ‚ń–ņ•Ø—Ć–@‚Č‚¢‚µ•śŽĖü—Ć–@‚ĢŽĄŽ{‘O–é‚©‚ē“Š—^‚·‚éB’Źķ1 ‰ń0.2`0.4mg ‚š1 “ś3 ‰ń‚©‚ēŠJŽn‚µC•K—v‚ɉž‚¶‚X‚É‘—Ź‰ĀB‚—īŽŅ‚āĮ–Ր«Ž¾Š³‚Č‚ē‚Ń‚ÉdĒŠĢįŠQŠ³ŽŅ‚Å‚ĶC1 ‰ń0.2 mg ‚š 1 “ś2`3 ‰ń“Š—^‚©‚ēŠJŽn‚µC1 “ś1.2 mg ‚š’“‚¦‚Č‚¢‚±‚ʁB‚½‚¾‚µCCINV ‚É‘Ī‚·‚éŒų”\EŒų‰Ź‚š—L‚µ‚Ä‚Ø‚ē‚ø•ŪŒÆ“K—pŠO‚Å‚ ‚éB

‚Č‚ØCƒxƒ“ƒ]ƒWƒAƒ[ƒsƒ“ŒnR•sˆĄ–ņiƒƒ‰ƒ[ƒpƒ€CƒAƒ‹ƒvƒ‰ƒ]ƒ‰ƒ€j‚ĢŒų‰Ź‚ĶC‚Ŗ‚ń–ņ•Ø—Ć–@‚šŒp‘±‚·‚邤‚æ‚ɁCŒøŽć‚·‚éŒXŒü‚Ŗ‚ ‚éB

‚Ü‚½Cƒxƒ“ƒ]ƒWƒAƒ[ƒsƒ“ŒnR•sˆĄ–ņ‚š”ƒJŒŽˆČć‚É‚ķ‚½‚Į‚ĘA‘±Žg—p‚µ‚½ź‡‚ĶC‘QŒø‚µ‚½‚¤‚¦‚Å’†Ž~‚·‚邱‚ʁB

ŠCŠO‚Å‚ĶS—Šw“IŽ”—Ć–@‚Ę‚µ‚āCŒn““I’EŠ“ģ1j‚āƒŠƒ‰ƒNƒZ[ƒVƒ‡ƒ“‚ŖŽŽ‚Ż‚ē‚źC—LŒų«‚ŖŠm”F‚³‚ź‚Ä‚¢‚éB‚Ü‚½C¬Ž™‚ŃCƒ[ƒW“±“ü–@‚š—p‚¢‚éĆ–°—Ć–@‚Ģ—LŒų«‚Ŗ•ń‚³‚ź‚Ä‚¢‚é10jB‚µ‚©‚µC‚ķ‚Ŗ‘‚Å‚Ķ‚±‚ź‚ē‚ĢS—“IŽ”—ĆŽč’i‚šŽĄŽ{‚Å‚«‚éŽ{Ż‚ĶC‚²‚­ŒĄ‚ē‚ź‚Ä‚¢‚é‚Ģ‚ŖŽĄī‚Å‚ ‚éB

+ ŽQl‚É‚µ‚½“ńŽŸŽ‘—æ
  1. NCCN NCCN Clinical Practice Guidelines in Oncology-Antiemesis-ver. 2, 2017
  2. MASCC/ESMO Antiemetic Guidelines 2016
  3. Hesketh PJ, Kris MG, Basch E, Basch E, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017; 35: 3240-61.
ŽQl•¶Œ£
i jƒGƒrƒfƒ“ƒXƒŒƒxƒ‹

1j Morrow GR, Morrell C. Behavioral treatment for the anticipatory nausea and vomiting induced by cancer chemotherapy. N Engl J Med. 1982; 307: 1476-80.

iⅡ j

2j Morrow GR, Lindke J, Black PM. Predicting development of anticipatory nausea in cancer patients: prospective examination of eight clinical characteristics. J Pain Symptom Manage. 1991; 6: 215-23.

iⅣ j

3j Andrykowski MA, Jacobsen PB, Marks E, et al. Prevalence, predictors, and course of anticipatory nausea in women receiving adjuvant chemotherapy for breast cancer. Cancer. 1988; 62: 2607-13.

iⅣ j

4j Alba E, Bastus R, de Andres L, et al. Anticipatory nausea and vomiting: prevalence and predictors in chemotherapy patients. Oncology. 1989; 46: 26-30.

iⅣ j

5j Morrow GR. Prevalence and correlates of anticipatory nausea and vomiting in chemotherapy patients. J Nat Cancer Inst. 1982; 68: 585-8.

iⅣ j

6jChan A, Kim HK, Hsieh RK, et al. Incidence and predictors of anticipatory nausea and vomiting in Asia Pacific clinical practice\a longitudinal analysis. Support Care Cancer.@2015 ; 23 : 283-91.

iⅣ j

7) 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 Pain Symptom Manage. 2016 ; 51 : 987-93.

iⅣ j

8j Malik IA, Khan WA, Qazilbash M, et al. Clinical efficacy of lorazepam in prophylaxis of anticipatory, acute, and delayed nausea and vomiting induced by high doses of cisplatin. A prospective randomized trial. Am J Clin Oncol. 1995; 18: 170-5.

iⅡ j

9j Razavi D, Delvaux N, Farvacques C, et al. Prevention of adjustment disorders and anticipatory nausea secondary to adjuvant chemotherapy: A double-blind, placebo-controlled study of assessing the usefulness of alprazolam. J Clin Oncol. 1993; 11: 1384-90.

iIIIj

10j Redd WH, Andrykowski MA. Behavioral intervention in cancer treatment: controlling aversion reactions to chemotherapy. J Consult Clin Psychol. 1982; 50: 1018-29.

iⅣ j


Clinical QuestionE„§ˆź——‚Ö


CQ10
•śŽĖüŽ”—Ć‚É‚ę‚鈫SEšq“f‚š‚Ē‚Ģ‚ꂤ‚ÉŽ”—Ć‚·‚é‚©

„§ƒOƒŒ[ƒh

A •śŽĖüŽ”—Ć‚É‚ę‚鈫SEšq“f‚Ķ•śŽĖüĘŽĖ•”ˆŹ‚É‚ę‚č”­Œ»•p“x‚ŖˆŁ‚Č‚éB•śŽĖüĘŽĖ•”ˆŹ‚É‚ę‚čƒŠƒXƒN•Ŗ—Ž‚Ŗ‚Č‚³‚źC‚»‚ź‚ɉž‚¶‚½§“f—Ć–@‚Ŗ„§‚³‚ź‚Ä‚¢‚éB
+ ”wŒiE–Ś“I

•śŽĖüŽ”—Ć‚É‚ę‚鈫SEšq“f‚Ģ‚½‚ß‚ÉŽ”—ĆŒp‘±‚Ŗ¢“ļ‚Ę‚Č‚Į‚½‚čCQOL ‚Ģ’į‰ŗ‚š‚ą‚½‚ē‚·‚±‚Ę‚Ŗ‚ ‚éBĆ“f«ƒŠƒXƒN‚ɉž‚¶‚Ä“KŲ‚É‘Ī‰ž‚·‚邱‚Ę‚Ķ•śŽĖüŽ”—Ɛ‹sćd—v‚Å‚ ‚éBASCO ‚Ø‚ę‚ŃMASCC ‚Å‚Ķ•śŽĖü‚ĢĘŽĖ•”ˆŹ‚É‚ę‚čˆ«SEšq“f‚ĢƒŠƒXƒN•Ŗ—Ži•\1j‚šs‚¢C‚»‚ź‚ɉž‚¶‚½§“f—Ć–@‚Ŗ„§‚³‚ź‚Ä‚¢‚éB

•\1@•śŽĖüŽ”—Ć‚É‚ę‚鈫SEšq“f‚ĢƒŠƒXƒN•Ŗ—Ž‚Ø‚ę‚ŃŽ”—Ć–@
ˆ«SEšq“f‚ĢƒŠƒXƒN•Ŗ—Ž
i•p“xj
•śŽĖüĘŽĖ•”ˆŹ Ž”—Ć•ū–@
‚“xi„90“j ‘SgĘŽĖiTBIjC‘SƒŠƒ“ƒpßĘŽĖiTNIj —\–h“I5-HT3Žó—e‘ĢhR–ņ{ƒfƒLƒTƒƒ^ƒ]ƒ“
’†“™“xi60`90“j ć• •”C”¼gĘŽĖiHBIjCć”¼gĘŽĖiUBIj —\–h“I5-HT3Žó—e‘ĢhR–ņ}ƒfƒLƒTƒƒ^ƒ]ƒ“
Œy“xi30`59“j “ŖŠWC“ŖŠWŅ‘C“Ŗčņ•”C‹¹•”‰ŗ•”Cœ”Õ —\–h“I‚Ü‚½‚ĶĒó”­Œ»Œć5-HT3Žó—e‘ĢhR–ņ
Å¬“xiƒ30“j ŽlŽˆC“ū–[ Ēó”­Œ»Œć‚Ģƒhƒpƒ~ƒ“Žó—e‘ĢhR–ņ
‚Ü‚½‚Ķ5-HT3Žó—e‘ĢhR–ņ
+ ‰šą

•śŽĖüŽ”—Ć‚É‚ę‚éd“Ä‚Čˆ«SEšq“f‚Ģ‚½‚ߎ”—ĆŒp‘±‚Ŗ¢“ļ‚ɂȂ邱‚Ę‚Ŗ‚ ‚éBŽ”—Ć‹xŽ~CŽ”—Ć’†Ž~‚Ģź‡‚É‚ĶCŖŽ”«‚ɉe‹æ‚µ¶‘¶—¦‚Ŗ’į‰ŗ‚·‚éBŽ”—ĆŒp‘±‚Ŗ‰Ā”\‚Å‚ ‚鏼‡‚Å‚ąCˆ«SEšq“f‚Ŗ\•Ŗ‚ɐ§Œä‚Å‚«‚Č‚¢‚ĘŠ³ŽŅ‚ĢQOL ‚Ķ’į‰ŗ‚·‚é1j`4jB

•śŽĖüŽ”—Ć‚É‚ę‚鈫SEšq“f‚Ģ•p“xCd“Ä“x‚ĶC1 ‰ńü—ŹC‘ü—ŹCü—Ź—¦C•ŖŠ„‰ń”CĘŽĖ–ģ—eĻCĘŽĖ•”ˆŹCŠ³ŽŅ‘ĢˆŹC•śŽĖüŽ”—Ć‘OEŽ”—Ć’†‚Ģ•¹—pŽ”—Ć‚š‚Ķ‚¶‚ß‚Ę‚·‚é•śŽĖüŽ”—ĆˆöŽq‚Ø‚ę‚ŃŠ³ŽŅ‚Ģ‘Sgó‘Ō‚ɉe‹æ‚³‚ź‚é5jB•śŽĖüŽ”—ĆŠ³ŽŅ1,020 –¼‚Ģ‘OŒü‚«ŠĻŽ@Œ¤‹†‚É‚ę‚é‚ʁCˆ«SEšq“f‚Ģ”­Œ»•p“x‚Ķ27.9“iˆ«S‚Ģ‚Ż16.9“Cšq“f‚Ģ‚Ż0.8“Cˆ«S‚Ø‚ę‚Ńšq“f10.2“j‚Å‚ ‚Į‚½6jBˆ«SEšq“f‚ÉŠÖ—^‚·‚é•śŽĖüŽ”—ĆˆöŽq‚Å‚ĶCĘŽĖ–ģ‚Ģ‘å‚«‚³i„400 cm2j‚ʏʮĖ•”ˆŹ‚Ŗ—LˆÓ‚ČˆöŽq‚Å‚ ‚Į‚½BĘŽĖ•”ˆŹ•Ź‚Ģˆ«SEšq“f”­Œ»—¦‚ĶC“ū‘B22.8“Cœ”Õ•”24.1“C“Ŗčņ•”30.5“C‹¹•”31.0“C”]35.0“Cć• •”50.0“C”ē•†/ŽlŽˆ14.3“‚Å‚ ‚Į‚½B‘¼‚Ģ•ń‚Å‚ąCˆ«S”­Œ»—¦‚Ŗ39“i“ū‘B31“C• •”/œ”Õ63“CcŠu36“C“Ŗčņ•”46“C‘O—§‘B/äNć÷33“C”]45“C‚»‚Ģ‘¼29“jCšq“f”­Œ»—¦‚Ķ7“i• •”/œ”Õ15“j‚Ę‚Ł‚Ś“Æ—l‚ĢŒ‹‰Ź‚Å‚ ‚Į‚½4jB‘SgĘŽĖitotal body irradiation; TBIj‚Ģˆ«SEšq“f”­Œ»—¦‚Ķ80`100“‚ĘÅ‚ą‚‚¢7jB

5-HT3Žó—e‘ĢhR–ņ‚ĶCƒvƒ‰ƒZƒ{‚ā‘¼‚Ģ§“f–ņ‚ę‚č‚Ķ•śŽĖü‚É‚ę‚éšq“f‚š—LˆÓ‚É—\–h‚µ‚Ä‚¢‚邱‚Ę‚Ŗƒƒ^ƒAƒiƒŠƒVƒX‚É‚ę‚莦‚³‚ź‚Ä‚¢‚é8jBTBI ‚Å‚Ķ5-HT3Žó—e‘ĢhR–ņ‚Ģ—\–h“I“Š—^‚É‚ę‚鈫SEšq“f‚ĢŠ®‘S§ŒäŠ„‡‚Ŗ50`90“‚Ęƒvƒ‰ƒZƒ{‚ę‚č—LŒų«‚Ŗ‚‚©‚Į‚½9jBć• •”ĘŽĖ‚É‚Ø‚Æ‚é5-HT3Žó—e‘ĢhR–ņ‚Ģ—\–h“I“Š—^‚ĘƒƒgƒNƒƒvƒ‰ƒ~ƒhCƒvƒƒNƒ‰ƒ‹ƒyƒ‰ƒWƒ“‚ ‚é‚¢‚Ķƒvƒ‰ƒZƒ{‚Ģ—\–h“I“Š—^‚Ę‚Ģ•””‚Ģ‘ęIII‘Šƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚Å‚ĶC‚¢‚ø‚ź‚ą5-HT3Žó—e‘ĢhR–ņ‚ň«SEšq“f”­Œ»—¦‚Ŗ’į‚©‚Į‚½9jB‚Ü‚½C15 ‰ńˆČć‚Ģć• •”ĘŽĖ—į‚š‘ĪŪ‚É‚µ‚½–ˆ‰ń‚ĢĘŽĖ‚Å‚ĢƒIƒ“ƒ_ƒ“ƒZƒgƒƒ“’P“Ę‚ĘŽ”—ĆŠJŽn‚©‚ē5 •ŖŠ„ĘŽĖ‚Ü‚Å‚ĢƒfƒLƒTƒƒ^ƒ]ƒ“‚Ę‚Ģ•¹—p‚Ģ”äŠrŽŽŒ±‚Å‚ĶCƒfƒLƒTƒƒ^ƒ]ƒ“‚Ę‚Ģ•¹—p‚ň«SEšq“f‚ĢŒyŒø‚ŖŽ¦‚³‚ź‚Ä‚¢‚é2jB

ASCO ƒKƒCƒhƒ‰ƒCƒ“2017 ‚Ø‚ę‚ŃMASCC/ESMO ƒKƒCƒhƒ‰ƒCƒ“2016 ‚Å‚Ķ•śŽĖüĘŽĖ•”ˆŹ‚É‚ę‚郊ƒXƒN•Ŗ—Ži•\1j‚ŖŽ¦‚³‚źC‚»‚ź‚ɉž‚¶‚½§“f—Ć–@‚š„§‚µ‚Ä‚¢‚éB’†“™“xƒŠƒXƒN‚Å‚ĶASCO ‚Å‚Ķ5-HT3Žó—e‘ĢhR–ņ‚É•ŖŠ„ĘŽĖ‰Šśi1`5 •ŖŠ„j‚ĢƒfƒLƒTƒƒ^ƒ]ƒ“•¹—p‚š„§‚µ‚Ä‚¢‚é‚ŖCMASCC ‚Å‚ĶƒfƒLƒTƒƒ^ƒ]ƒ“•¹—p‚šĒ—į‚ɉž‚¶‚čs‚¤‚±‚Ę‚š„§‚µ‚Ä‚¢‚éBNCCN ƒKƒCƒhƒ‰ƒCƒ“2017 ‚Å‚ĶTBI ‚Ø‚ę‚Ńć• •”ĘŽĖ‚Å‚Ķ–ˆĘŽĖ‘O‚ĢƒOƒ‰ƒjƒZƒgƒƒ“‚ ‚é‚¢‚ĶƒIƒ“ƒ_ƒ“ƒZƒgƒƒ“’PÜ‚Ü‚½‚ĶƒfƒLƒTƒƒ^ƒ]ƒ“‚Ę‚Ģ•¹—p‚š„§‚µ‚Ä‚¢‚éB

‰»Šw•śŽĖü—Ć–@‚Å‚ĶC•śŽĖüŽ”—Ć‚Ģ‚Ł‚¤‚ŖƒŠƒXƒN‚Ŗ‚‚¢ź‡ˆČŠO‚ĶCR‚Ŗ‚ń–ņ‚ĢƒŠƒXƒN•Ŗ—Ž‚ɉž‚¶‚½„§•ū–@‚Å‘Ī‰ž‚·‚éB

‚ķ‚Ŗ‘‚Å‚ĶƒOƒ‰ƒjƒZƒgƒƒ“‚ŖTBI ‚Ģ‚Ż‚É•śŽĖüĘŽĖ‚É”ŗ‚¤Į‰»ŠķĒóiˆ«SEšq“fj‚ĢŒų”\EŒų‰Ź‚š—L‚µ‚Ä‚¢‚½‚ŖC2011 ”N11 ŒŽ‚É•śŽĖüĘŽĖ‘S”Ź‚š‘ĪŪ‚Ę‚µ‚ÄŒų”\‚Ŗ’Ē‰Į‚³‚ź‚½B‘¼‚Ģ5-HT3Žó—e‘ĢhR–ņ‚Ķ‚¢‚Ü‚¾•śŽĖüĘŽĖ‚É‘Ī‚·‚éŒų”\EŒų‰Ź‚š—L‚µ‚Ä‚¢‚Č‚¢B‚Ü‚½ƒhƒpƒ~ƒ“Žó—e‘ĢhR–ņ‚Å•śŽĖüĘŽĖ‚É”ŗ‚¤Į‰»ŠķĒóiˆ«SEšq“fj‚ĢŒų”\EŒų‰Ź‚š—L‚µ‚Ä‚¢‚é‚Ģ‚ĶƒƒgƒNƒƒvƒ‰ƒ~ƒh‚Ģ‚Ż‚Å‚ ‚éB‚ķ‚Ŗ‘‚Ģ“śķf—Ć‚Å‚ĶC‚»‚Ģ‘¼‚Ģƒhƒpƒ~ƒ“Žó—e‘ĢhRģ—p‚š—L‚·‚é–ņÜiƒvƒƒNƒƒ‹ƒyƒ‰ƒWƒ“Cƒhƒ“ƒyƒŠƒhƒ“j‚āƒfƒLƒTƒƒ^ƒ]ƒ“‚ŖŽg—p‚³‚ź‚邱‚Ę‚ą‘½‚¢B

•śŽĖüŽ”—Ć‚É‚ę‚鈫SEšq“f‚ĶCR‚Ŗ‚ń–ņ‚É‚ę‚é‚ą‚Ģ‚Ę”ä‚ׂĔ­Œ»•p“x‚Ŗ’į‚­Cd“Ä“x‚ą’į‚¢‚±‚Ę‚©‚ē‘½‚­‚Ģ•śŽĖüŽīį‡ˆć‚ĶŽĄ‘Ō‚ę‚č‚ą‰ß¬•]‰æ‚µ‚Ä‚Ø‚čC“śķf—Ć‚É‚Ø‚Æ‚é‘Ī‰ž‚Ķ\•Ŗ‚Ę‚Ķ‚¢‚¦‚Č‚¢4j6j10jB•śŽĖüŽ”—ĆŠ³ŽŅ‚Ö‚Ģ§“f–ņ“Š—^‚ĢŠ„‡‚Ķ’į‚­C17“‚É‚Ģ‚Ż§“f–ņ‚Ŗ“Š—^‚³‚ź‚½i—\–h“I“Š—^12.4“C”­Œ»Œć“Š—^4.6“j‚Ę‚¢‚¤•ń6j‚āCˆ«S”­Œ»Š³ŽŅ‚Ö‚Ģ“Š—^‚Ķ39“iRƒqƒXƒ^ƒ~ƒ“–ņ40“Cƒhƒpƒ~ƒ“Žó—e‘ĢhR–ņ37“C5-HT3Žó—e‘ĢhR–ņ17“j‚Å‚ ‚Į‚½‚Ę‚¢‚¤•ń‚Ŗ‚ ‚é4jBˆ«S”­Œ»Š³ŽŅ‚Ģ1/3 ‚ĶĒóŠÉ˜a‚Ŗ•s\•Ŗ‚Å‚ ‚č“KŲ‚Ȑ§“f—Ć–@‚š–]‚ń‚Å‚¢‚½4jB

+ ŽQl‚É‚µ‚½“ńŽŸŽ‘—æ
  1. NCCN Clinical Practice Guidelines in Oncology-Antiemesis-ver. 2, 2017
  2. MASCC/ESMO Antiemetic Guidelines 2016
  3. Hesketh PJ, Kris MG, Basch E, Basch E, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017; 35: 3240-61.
ŽQl•¶Œ£
i jƒGƒrƒfƒ“ƒXƒŒƒxƒ‹

1j Franzé n L, Nyman J, Hagberg H, et al. A randomised placebo controlled study with ondansetron in patients undergoing fractionated radiotherapy. Ann Oncol. 1996; 7: 587-92.

iⅡ j

2j Wong RK, Paul N, Ding K, et al. 5-hydroxytryptamine-3 receptor antagonist with or without short-course dexamethasone in the prophylaxis of radiation induced emesis: a placebo-controlled randomized trial of the National Cancer Institute of Canada Clinical Trials GroupiSC 19j. J Clin Oncol. 2006; 24: 3458-64.

iⅡ j

3j Sykes AJ, Kiltie AE, Stewart AL. Ondansetron versus a chlorpromazine and dexamethasone combination for the prevention of nausea and vomiting: a prospective, randomized study to assess efficacy, cost effectiveness and quality of life following single-fraction radiotherapy. Support Care Cancer. 1997; 5: 500-3.

iⅡ j

4j Enblom A, Bergius Axelsson B, Steineck G, et al. One third of patients with radiotherapy-induced nausea consider their antiemetic treatment insufficient. Support Care Cancer. 2009; 17: 23-32.

iIIIj

5j Feyer PC, Stewart AL, Titlbach OJ. Aetiology and prevention of emesis induced by radiotherapy. Support Care Cancer. 1998; 6: 253-60.

 

6j Maranzano E, De Angelis V, Pergolizzi S, et al. A prospective observational trial on emesis in radiotherapy: analysis of 1020 patients recruited in 45 Italian radiation oncology centres. Radiother Oncol. 2010; 94: 36-41.

iIIIj

7j Spitzer TR, Friedman CJ, Bushnell W, et al. Double-blind, randomized, parallel-group study on the efficacy and safety of oral granisetron and oral ondansetron in the prophylaxis of nausea and vomiting in patients receiving hyperfractionated total body irradiation. Bone Marrow Transplant. 2000; 26: 203-10.

iIIIj

8j Salvo N, Doble B, Khan L, et al. Prophylaxis of radiation-induced nausea and vomiting using 5-hydroxytryptamine-3 serotonin receptor antagonists: a systematic review of randomized trials. Int J Radiat Oncol. Biol Phys. 2012; 82: 408-17.

iⅠ j

9j Maranzano E, Feyer PCh, Molassiotis A, et al. Evidence-based recommendations for the use of antiemetics in radiotherapy. Radiother Oncol. 2005; 76: 227-33.

 

10j Goldsmith BJ. Antiemetic patterns of care for radiotherapy-induced nausea and vomiting. Proc Am Soc Clin Oncol. 2003; 22: abstr 2975.

iⅣ j


Clinical QuestionE„§ˆź——‚Ö


CQ11
ˆ«SEšq“f‚ĘŠÖ˜A‚·‚éˆöŽq‚É‚Ķ‚Ē‚Ģ‚ꂤ‚Č‚ą‚Ģ‚Ŗ‚ ‚é‚©

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+ ”wŒiE–Ś“I

‚Ŗ‚ń–ņ•Ø—Ć–@‚É”ŗ‚¤ˆ«SEšq“f‚ĶR‚Ŗ‚ń–ņ‚ĢŽķ—Ž‚É‘å‚«‚­ˆĖ‘¶‚·‚é‚ŖC‚»‚źˆČŠO‚ĢˆöŽq‚ą—‰š‚µ‚Ä‚Ø‚­•K—v‚Ŗ‚ ‚éB‚»‚ź‚ē‚šŽ”—Ć‘O‚É”cˆ¬‚·‚邱‚Ę‚É‚ę‚čC“IŠm‚Ȑ§“f—Ć–@‚šŽ{s‚µ“¾‚éB

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+ ŽQl‚É‚µ‚½“ńŽŸŽ‘—æ
  1. NCCN Clinical Practice Guidelines in Oncology-Antiemesis-ver. 2, 2017
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1j Warr D. Prognostic factors for chemotherapy induced nausea and vomiting. Eur J Pharmacol. 2014; 722: 192-6.

2j Sekine I, Segawa Y, Kubota K, et al. Risk factors of chemotherapy-induced nausea and vomiting: index for personalized antiemetic prophylaxis. Cancer Sci. 2013; 104: 711-7.

 

3j Tamura K, Aiba K, Saeki T, et al. Testing the effectiveness of antiemetic guidelines: results of a prospective registry by the CINV Study Group of Japan. Int J Clin Oncol. 2015; 20: 855-65.

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4j Takemoto H, Nishimura J, Komori T, et al. Combination antiemetic therapy with aprepitant/fosaprepitant in patients with colorectal cancer receiving oxaliplatin-based chemotherapy in the SENRI trial: analysis of risk factors for vomiting and nausea. Int J Clin Oncol. 2017; 22: 88-95.

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5j Dranitsaris G, Molassiotis A, Clemons M, et al. The development of a prediction tool to identify cancer patients at high risk for chemotherapy-induced nausea and vomiting. Ann Oncol. 2017; 28: 1260-1267.

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“Ėo«ˆ«SEšq“f §“f–ņ‚Ģ—\–h“I“Š—^‚š\•Ŗs‚Į‚Ä‚ąˆ«SEšq“f‚Ŗ”­Œ»EŒp‘±‚·‚éĒó‚Å‚ ‚éiCQ6jB•]‰æ‚É‚ĶCˆ«SEšq“f‚ĢŒ“ˆö‚ĢÄ•]‰æ‚šs‚¤‚Ę‚Ę‚ą‚ɁC—\–h‚Ę‚µ‚Ä—p‚¢‚鐧“f–ņ‚šŠ³ŽŅ‚Ŗ—\’č’Ź‚č‚É—p‚¢‚Ä‚¢‚½‚©‚šŠm”F‚µC§“f–ņ‚š•ĻX‚µ‚½ź‡‚Ķ‚»‚ĢŒų‰Ź‚É‚Ā‚¢‚Ä•]‰æ‚šs‚¤B
Ž”—ĆŒoŒ±‚Ģ‚ ‚é
Š³ŽŅ‚ĢŽ”—Ć‘O
—\Šś«ˆ«SEšq“f ‚Ŗ‚ń–ņ•Ø—Ć–@‚ā•śŽĖü—Ć–@‚É‚ę‚čˆ«SEšq“f‚šŒoŒ±‚µ‚½Š³ŽŅ‚ŖŽŸ‚ĢŽ”—Ć‚Ģ‘O‚Ɉ«SEšq“f‚š¶‚¶‚éĒó‚Å‚ ‚éiCQ9jBŠłŽ”—Ć‚É‚Ø‚Æ‚éˆ«SEšq“f—šCø_“I‚Č—vˆö‚Č‚Ē‚ƒŠƒXƒNŠ³ŽŅ‚š•]‰æ‚µC“KŲ‚Č‘Īˆ‚Ŗ•K—v‚Å‚ ‚éB
3jˆ«SEšq“f‚Ģ•]‰æ‚É—p‚¢‚éŠī€‚āŽŚ“x

ˆć—ĆŽŅ‚ĘŠ³ŽŅ‚Ģ”FŽÆ‚Ģˆį‚¢‚š‚Č‚­‚·‚½‚߁CĒó‚Ģ•]‰æ‚É‚ĶCŠ³ŽŅ‚Ø‚ę‚Ń‘½EŽķ‚Ģˆć—ĆŽŅ‚ŖŠī€‚ā•]‰æ•[‚Č‚Ē‹¤’Ź‚Ģ‚ą‚Ģ‚³‚µ‚š—p‚¢‚邱‚Ę‚Ŗ•K—v‚Å‚ ‚éB

i1j‚Ŗ‚ńŽ”—Ć‚É”ŗ‚¤ˆ«SEšq“f‚Ģ‹qŠĻ“I‚Č•]‰æ

‚Ŗ‚ńŽ”—Ć‚É”ŗ‚¤ˆ«SEšq“f‚Ģ‹qŠĻ“I‚Č•]‰æ‚É‚ĶC—LŠQŽ–Ū‹¤’Ź—pŒź‹K€v4.0 “ś–{Œź–óJCOG ”Łi—ŖĢ: CTCAE v4.0-JCOGj‚Ŗˆź”Ź“I‚É—p‚¢‚ē‚ź‚Ä‚¢‚éi•\3jB

•\3@‚Ŗ‚ńŽ”—Ć‚É”ŗ‚¤ˆ«SEšq“f‚Ģ‹qŠĻ“I‚Č•]‰æ
CTCAE v4.0
Term “ś–{Œź
Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
ˆ«S ŪHKŠµ‚ɉe‹æ‚Ģ‚Č‚¢H—~’į‰ŗ Œ°’˜‚Č‘ĢdŒø­C’E…‚Ü‚½‚Ķ‰h—{Žø’²‚š”ŗ‚ķ‚Č‚¢ŒoŒūŪŽę—Ź‚ĢŒø­ ƒJƒƒŠ[‚ā…•Ŗ‚ĢŒoŒūŪŽę‚Ŗ•s\•Ŗ; ŒoŠĒ‰h—{/TPN/“ü‰@‚š—v‚·‚é
šq“f 24 ŽžŠŌ‚É1`2ƒGƒsƒ\[ƒh‚Ģšq“fi5 •ŖˆČćŠŌŠu‚ŖŠJ‚¢‚½‚ą‚Ģ‚š‚»‚ź‚¼‚ź1 ƒGƒsƒ\[ƒh‚Ę‚·‚éj 24 ŽžŠŌ‚É3`5 ƒGƒsƒ\[ƒh‚Ģšq“fi5 •ŖˆČćŠŌŠu‚ŖŠJ‚¢‚½‚ą‚Ģ‚š‚»‚ź‚¼‚ź1 ƒGƒsƒ\[ƒh‚Ę‚·‚éj 24 ŽžŠŌ‚É6 ƒGƒsƒ\[ƒhˆČć‚Ģšq“fi5 •ŖˆČćŠŌŠu‚ŖŠJ‚¢‚½‚ą‚Ģ‚š‚»‚ź‚¼‚ź1 ƒGƒsƒ\[ƒh‚Ę‚·‚éj; TPN ‚Ü‚½‚Ķ“ü‰@‚š—v‚·‚é ¶–½‚š‹ŗ‚©‚·; ‹Ł‹}ˆ’u‚š—v‚·‚é Ž€–S

o“T: —LŠQŽ–Ū‹¤’Ź—pŒź‹K€v4.0 “ś–{Œź–óJCOG ”Å

ƒOƒŒ[ƒhiGradej‚Ŗ‚‚­‚Č‚é‚Ł‚ĒĒó‚Ŗ‹­‚­‚Č‚é‚ŖC•]‰æ‚ĶCŽ”—Ć‘OŒć‚ĢHŽ–ŪŽę—Ź‚Ģ•Ļ‰»C‘Ģd‚ĢŒø­C’E…‚ā‰h—{ó‘Ō‚Č‚Ē‚Ģ¶—Šw“I‚ČŽw•W‚š—p‚¢‚čs‚ķ‚ź‚éB‚»‚Ģ‚½‚߁CŽ”—Ć‘O‚Ģ•’i‚ĢHŽ–KŠµ‚āŽ”—Ć‘O‚Ģ‰h—{ó‘Ō‚šŠī€‚Ę‚Č‚éó‘Ō‚Ę‚µ‚Ä”cˆ¬‚µCŽ”—ĆŒć‚Ģó‘Ō‚Ę”äŠr‚µ•]‰æ‚šs‚¤B

šq“f‚Ģu1 ƒGƒsƒ\[ƒhv‚Ę‚ĶC1 ‰ńšq“f‚µ‚½‚±‚Ę‚šŽw‚·‚Ģ‚Å‚Ķ‚Č‚­Cšq“f”­ģ‚Ģˆź˜A‚ĢŒo‰ß‚Ģ‚±‚Ę‚Å‚ ‚čC’ZŽžŠŌ‚ɘA‘±‚µ‚Ä2C3 ‰ń‚Ģšq“f‚Ŗ‚ ‚Į‚½‚Ę‚µ‚Ä‚ąC‚»‚ź‚Ķu1 ƒGƒsƒ\[ƒhv‚Ę‚µ‚ăJƒEƒ“ƒg‚³‚ź‚éB

i2jŠ³ŽŅ‚ĢŽåŠĻ“I•]‰æ

① •]‰æ‚É—p‚¢‚鎌“x

ˆ«S‚ĶCŽåŠĻ“I‚ȏĒó‚Å‚ ‚čCˆČ‰ŗ‚Ģ•ū–@‚Å•]‰æ‚·‚邱‚Ę‚Ŗ‚Å‚«‚éB‚¢‚ø‚ź‚ą’É‚Ż‚Ģ•]‰æ‚É•p—p‚³‚ź‚é‚ŖCˆ«SEšq“f‚É‚ą—p‚¢‚ē‚ź‚Ä‚¢‚éB

Visual Analogue ScaleiVASj‚ĶCĒó‚Ģ‹­‚³‚É‚Ā‚¢‚Ä100 mm ‚Ģüć‚É‹LŚ‚µ‚Ä‚ą‚ē‚¤‚ą‚Ģ‚ŁCŠČ•Ö‚Å’ZŽžŠŌ‚Å‹LŚ‰Ā”\‚Å‚ ‚é‚ŖCŒū“Ŗ‚ā“d˜b‚Å‚Ģ•]‰æ‚É‚Ķ—p‚¢‚邱‚Ę‚Ŗ‚Å‚«‚Č‚¢i}1ajB‚³‚Ü‚“‚Ü‚ČŒ¤‹†“™‚Å—p‚¢‚ē‚źCM—Š«‚ą‚‚¢B‚µ‚©‚µC‚—īŽŅ‚Å”F’m‹@”\‚Ŗ’į‰ŗ‚µ‚Ä‚¢‚鏼‡‚É‚Ķ—‰š‚Ŗ“ļ‚µ‚¢B‚Ü‚½CS—“IˆöŽq‚ŖĒó‚ÉŠÖ˜A‚µ‚Ä‚¢‚鏼‡‚Ķ•sŒü‚«‚Å‚ ‚é‚Ę•ń‚³‚ź‚Ä‚¢‚é5jB

Numerical Rating ScaleiNRSj‚ĶC”‚Ü‚ÅŠ“‚¶‚½Åˆ«‚ĢĒó‚š10CĒó‚Ŗ‚Č‚¢ó‘Ō‚š0 ‚Ę‚µ‚ÄŒ»Ż‚Ķ‰½“_‚©‚š“š‚¦‚Ä‚ą‚ē‚¤‚ą‚Ģ‚Å‚ ‚é5ji}1bjB

Verbal Rating ScaleiVRSj‚ĶĒó‚Ģ‹­‚³‚Ŗ‰½’iŠK–Ś‚É‚ ‚½‚é‚©‚Å•]‰æ‚·‚é•ū–@‚Å‚ ‚éi}1cjBŒ¾—t‚Ŗ—‰š‚Å‚«‚Č‚¢¬Ž™‚É‚Ķ“K‚³‚Č‚¢5jB

ƒtƒF[ƒXƒXƒP[ƒ‹‚ĶCŒ¾—t‚ŏĒó‚Ģ‹­‚³‚š•\Œ»‚·‚é‘ć‚ķ‚č‚ɐlŠŌ‚Ģ•\ī‚ÅŽ¦‚µ‚½‚ą‚Ģ‚ŁC¬Ž™‚Å•p—p‚³‚źC6 ’iŠK‚Å•\‚µ‚½Wong-Baker Face Scale ‚ŖÅ‚ą‚ę‚­Žg—p‚³‚ź‚Ä‚¢‚é6ji}1djB

}1@ˆ«S‚ĢŽåŠĻ“I•]‰æ•ū–@ }1@ˆ«S‚ĢŽåŠĻ“I•]‰æ•ū–@

}1@ˆ«S‚ĢŽåŠĻ“I•]‰æ•ū–@

② PRO-CTCAE™ “ś–{Œź”Å

—LŠQŽ–Ū‹¤’Ź—pŒź‹K€v4.0 “ś–{Œź–óJCOG ”Łi—ŖĢ: CTCAE v4.0-JCOGj‚ĢCŽåŠĻ“I•]‰æ‚ÉŠˆ—p‚·‚邽‚߂ɁCŠ³ŽŅ‚Ŗ‹L“ü‚Å‚«‚éPRO-CTCAETM ‚ŖŠJ”­‚³‚ź7jC“ś–{Œź”Å‚Ģ‘Ć“–«‚ŖŒŸŲ‚³‚ź‚½8j 9jB–{ŽŚ“x‚ĶC‘S80€–Ś‚ę‚č‚Č‚é‚ŖC‚»‚Ģ’†‚ŁCu“f‚«‹CvEušq“fv‚ÉŠÖ‚·‚é•]‰æ€–Ś‚ŖŻ’č‚³‚ź‚Ä‚¢‚é(‘˜_ •\5 ŽQĘ)B

③ ‚Ŗ‚ńŽ”—Ć‚ĢQOL •ļŠ‡“IŽŚ“x‚ɂ؂Ƃ鈫SEšq“f‚Ģ•]‰æ

‚Ŗ‚ńŽ”—Ć‚šŽó‚Ƃ銳ŽŅ‚ĢQOL ‚š‘Ŗ’č‚·‚鎌“x‚ÉŠÜ‚Ü‚ź‚鈫SEšq“f‚Ģ•]‰æ‚ĶˆČ‰ŗ‚Ģ’Ź‚č‚Å‚ ‚éi•\4jB

European Organization for Research and Treatment of Cancer: Quality of Life Questionnaire: Core 30iEORTC QLQ-C30Cver. 3.0j‚ĶC‹@”\–Ź5 ‘¤–Ź‚ʏĒó3 ‘¤–ŹC•ļŠ‡“I‚ČŒ’Nó‘Ō/QOL ‚Ģ1 ‘¤–ŹC‚Ø‚ę‚Ń‚Ŗ‚ńŠ³ŽŅ‚Ɉź”Ź“I‚ɐ¶‚¶‚é‚»‚Ģ‘¼‚ĢĒóiŒÄ‹z¢“ļCH—~•sUC•s–°C•Ö”éC‰ŗ—Ÿj‚ʁCŽ¾Š³‚ĢŒoĻ–Ź‚Ö‚Ģ‰e‹æ‚š•]‰æ‚·‚鍀–Ś‚ŖŠÜ‚Ü‚ź‚Ä‚¢‚é9j10jB

Functional Assessment of Cancer Therapy-GeneraliFACT-Gj‚ĶC‚Ŗ‚ńŠ³ŽŅ‚Ģ QOL ‚šg‘Ģ–ŹCŽŠ‰ļ–Ź/‰Ę‘°–ŹCī–ŹC‹@”\–Ź‚Ģ4 ŽŸŒ³‚É‚Ā‚¢‚Ä‘Ŗ’č‚·‚é‚ą‚Ģ‚Å‚ ‚é11j12jB

“ś–{‚ÅŠJ”­‚³‚ź‚½QOL ŽŚ“x‚Å‚ ‚éC‚Ŗ‚ń–ņ•Ø—Ć–@‚É‚Ø‚Æ‚éQOL ’²ø•[iQuality of Life Questionnaire for Cancer Patients Treated with Anticancer Drugs: QOL-ACDj‚ĶCŠˆ“®«Cg‘Ģó‹µCø_ES—ó‘ŌCŽŠ‰ļ«‚Ģ4 —Ģˆę‚š‘Ŗ’č‚·‚é‚ą‚Ģ‚Å‚ ‚é13)B

•\4@‚Ŗ‚ńŽ”—Ć‚ĢQOL •ļŠ‡“IŽŚ“x‚ɂ؂Ƃ鈫SEšq“f‚Ģ•]‰æ
ŽŚ“x–¼
ˆ«SEšq“f‚ÉŠÖ˜A‚·‚éŽæ–ā€–Ś
‹­‚³‚š•]‰æ‚·‚é—pŒź
EORTC QLQ-C30
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1D‚Ü‚Į‚½‚­‚Č‚¢@2D­‚µ‚ ‚é@3D‘½‚¢
4D‚Ę‚Ä‚ą‘½‚¢
FACT-G
E“f‚«‹C‚Ŗ‚·‚éB
1D‚Ü‚Į‚½‚­‚ ‚Ä‚Ķ‚Ü‚ē‚Č‚¢
3D‘½­‚ ‚Ä‚Ķ‚Ü‚é
5D”ńķ‚É‚ę‚­‚ ‚Ä‚Ķ‚Ü‚é
2D‚ķ‚ø‚©‚É‚ ‚Ä‚Ķ‚Ü‚é
4D‚©‚Č‚č‚ ‚Ä‚Ķ‚Ü‚é
QOL-ACD
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1D‚ę‚­“f‚¢‚½`5D‘S‚­“f‚©‚Č‚©‚Į‚½
‚Ģ5’iŠK

④ ˆ«SEšq“f‚É“ĮˆŁ“I‚ČŽæ–ā•[

Œ»ŻCˆ«SEšq“f‚š“ĮˆŁ“I‚É‘Ŗ’č‚·‚邽‚ß‚É“ś–{Œź‚Å‚ąŠˆ—p‚Å‚«‚éŽæ–ā•[‚ĶC•\5 ‚Ģ’Ź‚č‚Å‚ ‚éB

MATiMASCC Antiemesis Toolj‚ĶCMASCC ‚Ģˆ«SEšq“f‚Ģ‘Ŗ’莌“x‚Å‚ ‚čC‹}«‚Ø‚ę‚Ń’x”­«i24 ŽžŠŌˆČ“ą‚Ø‚ę‚ŃŽ”—ĆŒć4 “śŠŌj‚Ģˆ«SEšq“f‚Ģ•p“x‚Ę‹­“x‚š‘Ŗ’肵Cis‚Ŗ‚ńŠ³ŽŅC‚Ŗ‚ń–ņ•Ø—Ć–@Ž{sŠ³ŽŅ‚š‘ĪŪ‚É—p‚¢‚ē‚ź‚Ä‚¢‚é14j`16jB

Index of NauseaCVomitingCand RetchingiINVRj‚ĶCˆ«SEšq“fE‹óšq“firetchingj‚»‚ź‚¼‚ź‚Ģ•p“xCŽ‘±ŽžŠŌCdĒ“xC‹ź’É‚Ģ’ö“x‚š‘Ŗ’č‚Å‚«C‚Ŗ‚ń–ņ•Ø—Ć–@‚šŽó‚Æ‚Ä‚¢‚銳ŽŅC“ū‚Ŗ‚ńŠ³ŽŅ‚š‘ĪŪ‚É—p‚¢‚ē‚ź‚Ä‚¢‚é17j18jB“ś–{Œź”Å‚Ķˆ«SEšq“f‚Ģ‚Ż‚Ģ\¬‚Å‚ ‚éB

•\5@ˆ«SEšq“f‚É“ĮˆŁ“I‚ČŽæ–ā•[
–¼Ģ “Į’„
MASCC ‚Ģ•]‰æŽŚ“x“ś–{Œź”ŁiMASCC Antiemesis Tool; MATj ‹}«‚Ø‚ę‚Ń’x”­«i24 ŽžŠŌˆČ“ą‚Ø‚ę‚ŃŽ”—ĆŒć4 “śŠŌj‚Ģˆ«SEšq“f‚Ģ•p“x‚Ę‹­“x‚Ģ‘Ŗ’č‚É—p‚¢‚邱‚Ę‚Ŗ‚Å‚«‚éB
ˆ«SEšq“f‚ĢŽw•W“ś–{Œź”ŁiIndex of Nausea, Vomiting, and Retching; INVRj Œ“•¶‚Å‚ĶCˆ«SEšq“fE‹óšq“firetchingj‚»‚ź‚¼‚ź‚Ģ•p“xCŽ‘±ŽžŠŌCdĒ“xC‹ź’É‚Ģ’ö“x‚š‘Ŗ’č‚Å‚«‚é‚ŖC“ś–{Œź”Å‚Ķˆ«SEšq“f‚Ģ‚Ż‚Ģ‹LŚ‚Ę‚Č‚Į‚Ä‚¢‚éB
4j§“f–ņ‚Ģ•ž–ņó‹µ‚ÉŠÖ‚·‚é•]‰æ

‚Ŗ‚ńŽ”—Ć‚ĘCINV Œ¤‹†‰ļ‚É‚ę‚é‘å‹K–Ķ’²ø‚É‚ę‚é‚ʁC“ś–{‚ɂ؂Ƃ鐧“f–ņ“K³Žg—pƒKƒCƒhƒ‰ƒCƒ“…Žē—¦‚ĶC‹}«ˆ«SEšq“f‚Å‚Ķ74“C’x”­«ˆ«SEšq“f‚Å‚Ķ95“‚Å‚ ‚čC‰¢•Ä‚É‚Ø‚Æ‚é’²ø‚É”äŠr‚µC‚‚¢…Žē—¦‚Å‚ ‚邱‚Ę‚Ŗ•ń‚³‚ź‚½3jB

§“f–ņ‚ĢŽg—p‚É‚Ā‚¢‚Ä‚ĶCŒoŒū–ņ‚Ŗ‘‰Į‚µCŠ³ŽŅ‚ĢŽ©ŒČŠĒ—‚Ŗd—v‚Ę‚Č‚Į‚Ä‚¢‚邱‚Ę‚āC’x”­«‚Ģˆ«SEšq“f‚Ę‚µ‚āC7 “ś–Ś‚ĢĒó‚Ģ‹­‚³‚Ŗ•ń‚³‚ź‚Ä‚¢‚邱‚Ę3j‚Č‚Ē‚©‚ēCŽwŽ¦’Ź‚č‚É•ž–ņ‚µ‚Ä‚¢‚é‚©‚š•]‰æ‚·‚é•K—v‚Ŗ‚ ‚éB

5j§“f–ņ‚ĢŽ”—ĆŒų‰Ź

§“f–ņ‚ĢŽ”—ĆŒų‰Ź‚Ģ’č‹`‚É‚Ā‚¢‚Ä‚ĶC‘˜_-•\4 ‚šŽQl‚Ę‚·‚éB

+ ŽQl‚É‚µ‚½“ńŽŸŽ‘—æ
  1. NCCN Clinical Practice Guidelines in Oncology-Palliative Care-ver. 1, 2017
  2. NCCN Clinical Practice Guidelines in Oncology-Antiemesis-ver. 2, 2017
  3. Hesketh PJ, Kris MG, Basch E, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017; 35: 3240-61.
  4. ONSiOncology Nursing Societyj, Chemotherapy and Biotherapy Guidelines and Recommendations for PracticeiFourth Editionj, 2014
  5. ONSiOncology Nursing SocietyjPutting Evidence into PracticeiPEPj: Improving Oncology Patient Outcomes, 2014
  6. NCI Common Terminology Criteria for adverse eventsiCTCAEjver. 4
  7. “ś–{ŠÉ˜aˆć—ĆŠw‰ļ•ŅD‚Ŗ‚ńįu’É‚Ģ–ņ•Ø—Ć–@‚ÉŠÖ‚·‚éƒKƒCƒhƒ‰ƒCƒ“@2014”N”ŁD‹ąŒ“o”ŁC“Œ‹žC2014D
ŽQl•¶Œ£
i jƒGƒrƒfƒ“ƒXƒŒƒxƒ‹

1j Teunissen SC, Wesker W, Kruitwagen C, et al. Symptom prevalence in patients with incurable cancer: a systematic review. J Pain Symptom Manage. 2007; 34: 94-104.

iⅠ j

2j Vidall C, Ferná ndez-Ortega P, Cortinovis D, et al. Impact and management of chemotherapy/radiotherapy-induced nausea and vomiting and the perceptual gap between oncologists/oncology nurses and patients: a cross-sectional multinational survey. Support Care Cancer. 2015.

iⅣ j

3j Tamura K, Aiba K, Saeki T, et al. Testing the effectiveness of antiemetic guidelines: results of a prospective registry by the CINV Study Group of Japan. Int J Clin Oncol. 2015; 20: 855-65

iIIIj

4j Naeim A, Dy SM, Lorenz KA, et al. Evidence-based recommendations for cancer nausea and vomiting. J Clin Oncol. 2008; 26: 3903-10.

iⅣ j

5j Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: Visual Analog Scale for PainiVAS Painj, Numeric Rating Scale for PainiNRS Painj, McGill Pain Questionnaire iMPQj, Short-Form McGill Pain QuestionnaireiSF-MPQj, Chronic Pain Grade Scale iCPGSj, Short Form-36 Bodily Pain ScaleiSF-36 BPSj, and Measure of Intermittent and Constant Osteoarthritis PainiICOAPj. Arthritis Care ResiHobokenj. 2011; 63 Suppl 11: S240-52.

iⅠ j

6j Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain. 1997; 72: 95-7.

iⅥ j

7j PRO-CTCAE™ “ś–{Œź”Å.
https: //healthcaredelivery.cancer.gov/pro-ctcae/pro-ctcae_japanese.pdfiaccessed January 18, 2018j

8j Miyaji T, Iioka Y, Kuroda Y, et al. Japanese translation and linguistic validation of the US National Cancer Institutefs Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse EventsiPRO-CTCAEj, Journal of Patient-Reported Outcomes ,2017; 1: 8 DOI 10.1186/s41687-017-0012-7

iⅥ j

9j Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993; 85: 365-76.

iⅥ j

10j Kobayashi K, Takeda F, Teramukai S, et al. A cross-validation of the European Organization for Research and Treatment of Cancer QLQ-C30iEORTC QLQ-C30jfor Japanese with lung cancer. Eur J Cancer. 1998; 34: 810-5.

iⅣ j

11j Cella DF, Tulsky DS, Gray G, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol. 1993; 11: 570-9.

iⅣ j

12j Fumimoto H, Kobayashi K, Chang CH, et al. Cross-cultural validation of an international questionnaire, the General Measure of the Functional Assessment of Cancer Therapy scaleiFACT-Gj, for Japanese. Qual Life Res. 2001; 10: 701-9.

iⅣ j

13j Development of quality of life questionnaire in Japan: quality of life assessment of cancer patients receiving chemotherapy. Psychooncology. 1999; 8: 355-63.

iⅣ j

14j Multinonal Association of Supportive Care in Cancer: MASCC antiemesis tooil MATj

iⅣ j

15j Molassiotis A, Coventry PA, Stricker CT, et al. Validation and psychometric assessment of a short clinical scale to measure chemotherapy-induced nausea and vomiting: the MASCC antiemesis tool. J Pain Symptom Manage. 2007; 34: 148-59.

iⅣ j

16j Matsuda Y, Okita K, Furuhata T, et al. Evaluation of the validity of chemotherapy- induced nausea and vomiting assessment in outpatients using the Japanese version of the MASCC antiemesis tool. Support Care Cancer. 2015; 23: 331-9.

iⅣ j

17j Rhodes VA, McDaniel RW. The Index of Nausea, Vomiting, and Retching: a new format of the Index of Nausea and Vomiting. Oncol Nurs Forum. 1999; 26: 889-94.

iⅣ j

18j Arakawa S. Relaxation to reduce nausea, vomiting, and anxiety induced by chemotherapy in Japanese patients. Cancer Nurs. 1997; 20: 342-9.

iⅤ j


Clinical QuestionE„§ˆź——‚Ö


CQ13
’Ź‰@‰Į—Ć’†‚Ģˆ«SEšq“f‚Ģƒ}ƒl[ƒWƒƒ“ƒg‚šs‚¤‚É‚Ķ‚Ē‚¤‚·‚ź‚Ī‚ę‚¢‚©

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C1 „§‚³‚ź‚鎔—Ć‚Ķ‚Č‚¢‚ŖCŻ‘ī‰Į—Ć’†‚Ģˆ«SEšq“f‚Ģƒ}ƒl[ƒWƒƒ“ƒg‚Ķd—v‚Å‚ ‚邽‚߁CƒGƒrƒfƒ“ƒX‚ÉŠī‚Ć‚¢‚½‰Į—Ć‚šs‚¤B
+ ”wŒiE–Ś“I

‹ß”NCR‚Ŗ‚ń–ņŽ”—Ć‚ĶŠO—ˆ‚É‚Ø‚¢‚ÄŽ{s‚·‚é‹@‰ļ‚Ŗ‘‚¦‚Ä‚Ø‚čC’Ź‰@Ž”—ĆŒć‚ĢŻ‘ī‚Å‚ĢŠ³ŽŅ‚Ģˆ«SEšq“f‚Ģƒ}ƒl[ƒWƒƒ“ƒg‚Ķ‹É‚߂ďd—v‚Å‚ ‚éBŻ‘ī‚Å‚ĢĻ‹É“I‚Čˆ«SEšq“f‚Ģƒ}ƒl[ƒWƒƒ“ƒg‚šs‚¤‚±‚Ę‚ĶŠ³ŽŅ‚ĢŽ”—Ɛ¬Ń‚āQOL ‚É’¼Œ‹‚·‚éd—v‚ȉŪ‘č‚Å‚ ‚éB

+ ‰šą

š”CR‚Ŗ‚ń–ņ‚É‚ę‚鎔—Ć‚šŠO—ˆ‚É‚Ø‚¢‚ÄŽ{s‚·‚é‹@‰ļ‚Ŗ‘‚¦‚Ä‚Ø‚čCŽ”—ƏI—¹Œć‚ɁCˆć—ĆƒXƒ^ƒbƒt‚Ģ–Ś‚Ģ“Ķ‚©‚Č‚¢Ż‘ī‚ɂ؂Ƃ鈫SEšq“f‚šƒ}ƒl[ƒWƒƒ“ƒg‚·‚邱‚Ę‚ĶŠ³ŽŅ‚ĢQOL ‚É’¼Œ‹‚·‚éd—v‚Č–ā‘č‚Å‚ ‚éBŻ‘ī’†‚ĢŠ³ŽŅ‚É‚Ā‚¢‚Đ³Šm‚ȏĒóƒ‚ƒjƒ^ƒŠƒ“ƒO‚šs‚¤‚±‚Ę‚Ķ¢“ļ‚Å‚ ‚čCŻ‘ī’†‚Ģˆ«S‚ŖŠ³ŽŅ‚Ģ¶Šˆ‚É‹y‚Ś‚·‰e‹æ‚Ķ‘å‚«‚¢1j‚ĘŽv‚ķ‚ź‚éB‚Ü‚½Š³ŽŅ‚ĶCˆć—ƍsˆ×‚Ģ’†‚Å’x”­Šś‚Ģˆ«S‚ĢƒRƒ“ƒgƒ[ƒ‹‚šÅ—Dę‚·‚邱‚Ę‚š–]‚Ž‚Ę‚·‚éŠCŠO‚Å‚Ģ•ń‚ą‚ ‚é2jB

‚³‚ē‚É‚ķ‚Ŗ‘‚Å‚ĢC‚Ŗ‚ń–ņ•Ø—Ć–@‚É‚ę‚č—U“±‚³‚ź‚½ˆ«SEšq“f‚ÉŠÖ‚·‚鑽Ž{Ż‹¤“Æ‘å‹K–ĶƒAƒ“ƒP[ƒg’²ø‚Å‚ĶC‹}«Šś‚ę‚č‚ą’x”­Šś‚Ģˆ«SEšq“f‚ĢƒRƒ“ƒgƒ[ƒ‹‚ŖCŠ³ŽŅ‚É‚Ę‚Į‚ďd—v‚Ȋ֐SŽ–‚Å‚ ‚邱‚Ę‚ŖŽ¦‚³‚źCŠ³ŽŅ‚Ģˆ«SEšq“fƒRƒ“ƒgƒ[ƒ‹‚ɂ؂Ƃ鐧“f—Ć–@‚Ģ•K—v«‚Ŗ‰‚ß‚Ä–¾‚ē‚©‚É‚³‚ź‚½3jB

–{ƒKƒCƒhƒ‰ƒCƒ“‚Å‚Ķ‚»‚ź‚¼‚ź‚ĢĆ“f«ƒŠƒXƒN‚ɉž‚¶‚āC‹}«ŠśC’x”­Šś‚Ģˆ«SEšq“f‚ĢƒRƒ“ƒgƒ[ƒ‹‚š„§‚µ‚Ä‚Ø‚čC’x”­Šś‚É‚Ā‚¢‚Ä‚ąŠī–{“I‚É‚ĶCQ3CCQ6CCQ7CCQ9 “™‚Ģ€‚šŽQl‚ɃGƒrƒfƒ“ƒX‚ÉŠī‚Ć‚¢‚½‰Į—Ć‚šs‚¤‚±‚Ę‚Ŗ„§‚³‚ź‚éB‚µ‚©‚µC’x”­Šś‚Ģ§“f—Ć–@‚Ƀ^[ƒQƒbƒg‚ši‚č—L—p«‚šŽ¦‚µ‚½ƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚Ķ”‘½‚­s‚ķ‚ź‚Ä‚¢‚é‚ķ‚Æ‚Å‚Č‚­C‚Ü‚½§“f—Ć–@‚É‚Ā‚¢‚Ä‚¢‚­‚Ā‚©‚ĢƒIƒvƒVƒ‡ƒ“‚šÅ’įŒĄ‚ĢƒGƒrƒfƒ“ƒX‚ÉŠī‚Ć‚¢‚Ä’ńŽ¦‚µ‚Ä‚¢‚é‚Ģ‚ŖŒ»ó‚Å‚ ‚éB

‚µ‚©‚µ‘Oq‚Ģ‚ꂤ‚ɐĻ‹É“I‚É’x”­Šś‚Ģˆ«SEšq“f‚ĢƒRƒ“ƒgƒ[ƒ‹‚šs‚¤‚±‚Ę‚Ķ‚»‚Ģ•K—v«‚©‚ēd—v‚ȉŪ‘č‚Å‚ ‚čCˆ«SEšq“f‚Ģƒ}ƒl[ƒWƒƒ“ƒg‚ĶC§“f–ņ‚¾‚Ƃōs‚¤‚Ģ‚Å‚Ķ‚Č‚­C\•Ŗ‚ȏĒóƒ‚ƒjƒ^ƒŠƒ“ƒO‚ÉŠī‚Ć‚¢‚½R‚Ŗ‚ń–ņ‚Ģ’†Ž~EŒø—ŹCƒXƒ^ƒbƒt‚É‚ę‚é•ØS—¼–Ź‚ĢŠ³ŽŅƒTƒ|[ƒg‚ąd—v‚Å‚ ‚邱‚Ę‚Ķ˜_‚š‘Ņ‚½‚Č‚¢B

‚Ü‚½]—ˆC—Տ°ŽŽŒ±‚É‚Ø‚¢‚Ч“f–ņ‚Ģ—L—p«‚š•]‰æ‚·‚éŽå—v•]‰æ€–Ś‚Ę‚µ‚Ä‹}«Šś‚Ģˆ«SEšq“f‚Ģ§ŒäŠ„‡‚šŻ’č‚·‚é‚ą‚Ģ‚Ŗ‘½‚©‚Į‚½‚ŖC‹ß”N‚Å‚ĶŽå—v•]‰æ€–Ś‚Ę‚µ‚Ä’x”­Šś‚Ģˆ«SEšq“f‚ĢŠ®‘S§ŒäŠ„‡‚ā§ŒäŠ„‡‚šŻ’č‚·‚é—Տ°ŽŽŒ±‚Ŗ‘‚¦‚Ä‚Ø‚čC”Œć‚ĢŒŸ“¢‚ÉŠś‘Ņ‚µ‚½‚¢B

+ ŽQl‚É‚µ‚½“ńŽŸŽ‘—æ
  1. NCCN Clinical Practice Guidelines in Oncology-Antiemesis-ver. 2, 2017
  2. MASCC/ESMO Antiemetic Guidelines 2016
  3. Hesketh PJ, Kris MG, Basch E, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017; 35: 3240-61.
ŽQl•¶Œ£
i jƒGƒrƒfƒ“ƒXƒŒƒxƒ‹

1j Ihbe-Heffinger A, Ehlken B, Bernard R, et al. The impact of delayed chemotherapy-induced nausea and vomiting on patients, health resource utilization and costs in German cancer centers. Ann Oncol. 2004; 15: 526-36.

iⅡ j

2j Miller PJ, Balu S, Buchner D, et al. Willingness to pay to prevent chemotherapy induced nausea and vomiting among patients with breast, lung, or colorectal cancer. J Med Econ. 2013; 16: 1179-89.

iⅡ j

3j Tamura K, Aiba K, Saeki T, et al. Testing the effectiveness of antiemetic guidelines: results of a prospective registry by the CINV Study Group of Japan. Int J Clin Oncol. 2015.mEpub ahead of printn

iIIIj


Clinical QuestionE„§ˆź——‚Ö


CQ14
¬Ž™‚Ŗ‚ńŽ”—Ć‚É‚Ø‚Æ‚éˆ«SEšq“f‚É‚Ē‚Ģ‚ꂤ‚Č‘Īˆ‚š‚·‚é‚©

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B ¬Ž™‚É‚Ø‚¢‚Ä‚ą¬l‚Ę“Æ—li5-HT3Žó—e‘ĢhR–ņ‚Ø‚ę‚ŃƒfƒLƒTƒƒTƒ]ƒ“}NK1 Žó—e‘ĢhR–ņj‚Ģ§“f—Ć–@‚Ŗ„§‚³‚źC—Տ°ć\•Ŗ‚Ȑ§“fŒų‰Ź‚Ŗ“¾‚ē‚ź‚éB‚½‚¾‚µCŽg—p–ņÜ‚Ģ–{–M‚Å‚Ģ³”F“ą—ei¬Ž™“K‰ž‚ā—p—Źj‚šŠm”F‚·‚é•K—v‚Ŗ‚ ‚éB
+ ”wŒiE–Ś“I

¬Ž™Šś‚Ģˆ««Žīį‡‚Ķ‘ŁŽ™««Ši‚šŽ‚ĀŠŌ—tŒn—R—ˆ‚Ģ“÷Žī‚ŖŽå‘Ģ‚Å‚ ‚čC‚»‚ź‚ē‚Ģ‘½‚­‚Ķ–ņ•Ø—Ć–@‚ÉŠ“Žó«‚Ŗ‹É‚߂č‚‚­CŒŒ‰tŽīį‡‚Ģ‚Ż‚Č‚ē‚øCŒÅŒ`‚Ŗ‚ń‚É‚Ø‚¢‚Ä‚ą‚»‚ĢŽ”—Ć‚É‚Ø‚¢‚Ä–ņ•Ø—Ć–@‚Ŗ‚»‚ĢŽå‘Ģ‚Ę‚Č‚éŽ¾Š³‚Ŗ‘½‚¢B]‚Į‚āC“KŲ‚Ȑ§“f–ņ‚ĢŽg—p‚ŖŽ”—Ɛ‹sćC‹É‚߂ďd—v‚Å‚ ‚éB

‚±‚ź‚ē‚Ģ–ņ•ØŠ“Žó«‚Ģ‚‚¢Žīį‡ŒQ‚É•p—p‚³‚ź‚é–ņÜ‚ĶCƒhƒLƒ\ƒ‹ƒrƒVƒ“CƒVƒXƒvƒ‰ƒ`ƒ“CƒGƒgƒ|ƒVƒhCƒVƒNƒƒzƒXƒtƒ@ƒ~ƒhCƒCƒzƒXƒtƒ@ƒ~ƒhCƒAƒNƒ`ƒmƒ}ƒCƒVƒ“DC‘å—Źƒƒ\ƒgƒŒƒLƒT[ƒgC‘å—ŹƒVƒ^ƒ‰ƒrƒ““™C‚“x‚©‚ē’†“™“xĆ“f«ƒŠƒXƒN‚Ģ–ņÜ‚Ŗ‘å•”•Ŗ‚Å‚ ‚éB‚µ‚½‚Ŗ‚Į‚āC§“f–ņ‚Ģ“KŲ‚ČŽg—p‚ŖŠ³ŽŅ‚ĢQOL ‚š—ĒD‚ɈŪŽ‚µ‚Ā‚ĀCŒų‰Ź“I‚ČŽ”—ĆŠ®‹‚É•K{‚Å‚ ‚éB

+ ‰šą

¬Ž™Šś‚Ģˆ««Žīį‡–ņ•Ø—Ć–@‚ɂ؂Ƃ鐧“f–ņ‚É‚Ā‚¢‚Ä‚ĶC‚»‚Ģ‹H­«C‚»‚ź‚É”ŗ‚¤ĢŽZ«‚Ģ–ā‘č‚©‚ēCŽæ‚Ģ‚‚¢ƒGƒrƒfƒ“ƒX‚Ķ‹É‚߂ď­‚Č‚¢1, 2jB‚µ‚©‚µCASCO ‚āMASCC/ESMO ‚ĢƒKƒCƒhƒ‰ƒCƒ“‚É‚ąC¬Ž™‚ɐ„§‚³‚ź‚鐧“f–@‚Ŗ‹LŚ‚³‚ź‚Ä‚¢‚éB‚»‚ź‚ē‚Ķ¬Ž™‚©‚ē“¾‚ē‚ź‚½­”‚ĢƒGƒrƒfƒ“ƒX‚ʁC¬l—Ģˆę‚ÅŠm—§‚µ‚Ä‚¢‚鐧“f–@‚©‚ē‚Ģ‰‰ćˆ‚É‚ę‚Į‚ďq‚ׂē‚ź‚Ä‚¢‚é‚ŖCˆź”Ź—Տ°ćC[•Ŗ‚ȐM—Š«‚Ŗ‚ ‚é3jB¬Ž™‚Å‚ ‚邱‚Ę‚Ŗˆ«SEšq“f‚ĢƒŠƒXƒNˆöŽq‚É‚Č‚é‚©‚Ē‚¤‚©‚É‚Ā‚¢‚Ä‚Ķ”äŠrŽŽŒ±‚Ŗ–³‚¢‚Ģ‚ŃGƒrƒfƒ“ƒX‚Ę‚¢‚¦‚é‚ą‚Ģ‚Ķ–³‚¢‚ŖCŒoŒ±“I‚ɐ¬l‚ę‚萧“fƒRƒ“ƒgƒ[ƒ‹‚Ķ—eˆÕ‚Å‚ ‚éB

¬Ž™‚Å‚Ķšq‹C‚Ģ’ö“x‚Ģ•]‰æ‚ŖŽž‚ɍ¢“ļ‚Å‚ ‚éB‚Ę‚­‚ÉŽ©ŒČ‚ĢĒó‚šŒ¾Œź‰»‚·‚é‚Ģ‚Ŗ¢“ļ‚Č—cŽįŽ™‚Å‚ĶC‚»‚Ģ•\īC‘Sgó‘ŌCŪHs“®C‚³‚ē‚É‚Ķ—¼ei“Į‚É•źej‚ĢŠ“‚¶‚Ä‚¢‚é‰ä‚ŖŽq‚Ģ‹ź’ɁC“™‚š‘‡“I‚É”»’f‚·‚é•K—v‚Ŗ‚ ‚éB—cŽįŽ™‚Ķˆć—ĆŽŅ‚ÉŒ³‹C‚š‘•‚ķ‚Č‚¢‚Ģ‚ŁC‹ź’ɁEšq‹C‚Ģ”cˆ¬‚Ķ‚Ž‚µ‚ė—eˆÕ‚Å‚ ‚é‚Ę‚ąŒ¾‚¦‚éB

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+ ŽQl‚É‚µ‚½“ńŽŸŽ‘—æ
  1. Dupuis LL, Sung L, Molassiotis A, et al. 2016 updated MASCC/ESMO consensus recommendations: Prevention of acute chemotherapy-induced nausea and vomiting in children. Support Care Cancer. 2017
  2. Hesketh PJ, Kris MG, Basch E, et al. Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2017; 35: 3240-61.
  3. atel P, Robinson PD, Thackray J, et al. Guideline for prevention of acute chemotherapy-induced nausea and vomiting in pediatric cancer patients: A focused update. Periatr Blood Cancer. 2017
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1j Gore L, Chawla S, Petrilli A, et al. Aprepitant in adolescent patients for prevention of chemotherapy-induced nausea and vomiting: a randomized, double-blind, placebo-controlled study of efficacy and tolerability. Pediatr Blood Cancer. 2009; 52: 242-7.

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2j Kang JK, Loftus S, Taylor A, et al. Aprepitant for prevention of chemotherapy-induced nausea and vomiting in children: a randomised, double-blind, phase 3 trial. Lancet Oncol. 2015; 16: 385-94.

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3j Navari RM. Management of chemotherapy-induced nausea and vomiting in pediatric patients. Pediatr Drugs. 2017; 19 213-22.

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4j Navari RM, Qin R, Ruddy KJ, et al. Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting. N Engl J Med 2016; 375: 134-42.

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+ ŽQl‚É‚µ‚½“ńŽŸŽ‘—æ
  1. NCCN Clinical Practice Guidelines in Oncology-Antiemesis-ver. 2, 2017
  2. 2017 UpToDate Version 78.0gPrevention and treatment of chemotherapy-induced nausea and vomiting in adultsh
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1j Talley NJ, Meineche-Schmidt V, Paré P, et al. Efficacy of omeprazole in functional dyspepsia: double-blind, randomized, placebo-controlled trialsithe Bond and Opera studiesj. Aliment Pharmacol Ther. 1998; 12: 1055-65.

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+ ŽQl‚É‚µ‚½“ńŽŸŽ‘—æ
  1. NCCN Clinical Practice Guidelines in Oncology-Antiemesis-ver. 2, 2017
  2. 2017 UpToDate Version 78.0gPrevention and treatment of chemotherapy-induced nausea and vomiting in adultsh
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1j del Giglio A, Soares HP, Caparroz C, et al. Granisetron is equivalent to ondansetron for prophylaxis of chemotherapy-induced nausea and vomiting: results of a meta-analysis of randomized controlled trials. Cancer. 2000; 89: 2301-8.

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2j Grunberg S, Chua D, Maru A, et al. Single-dose fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting associated withcisplatin therapy: randomized, double-blind study protocol--EASE. J Clin Oncol. 2011; 29: 1495-501.

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Clinical QuestionE„§ˆź——‚Ö


CQ17
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ƒAƒvƒŒƒsƒ^ƒ“ƒg‚Ķƒ`ƒgƒNƒ[ƒ€P450iCytochrome P450; CYPj3A4 ‚ĢŠīŽæ‚Å‚ ‚čCŒy“x‚©‚ē’†“™“x‚ĢCYP3A4 ‘jŠQ‚Ø‚ę‚Ń—U“±ģ—p‚š—L‚µCCYP2C9 ‚Ģ—U“±ģ—p‚ą—L‚·‚éB‚»‚Ģ‚½‚ßCYP3A4 ‚Ø‚ę‚ŃCYP2C9 ‚É‚ę‚č‘ćŽÓ‚³‚ź‚é–ņÜ‚ĶCƒAƒvƒŒƒsƒ^ƒ“ƒg‚Ø‚ę‚ŃƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒg‚Ę‚Ģ•¹—pŽž‚ɁC‘ćŽÓ‘jŠQ‚É‚ę‚錌’†”Z“xćø‚ą‚µ‚­‚Ķ‘ćŽÓ—U“±‚É‚ę‚錌’†”Z“x’į‰ŗ‚š¶‚¶Cģ—p‚Ŗ‘‹­‚Ü‚½‚ĶŒøŽć‚·‚é‰Ā”\«‚Ŗ‚ ‚邽‚ß’ˆÓ‚š—v‚·‚éBCYP3A4 ‚É‚ę‚Į‚Ä‘ćŽÓ‚³‚ź‚é–ņÜ‚Ķ”ńķ‚É‘½‚­Cƒsƒ‚ƒWƒh‚ĶŒŒ’†”Z“x‚Ģćø‚É‚ę‚čQT ‰„’·‚āSŽŗ«•s®–¬‚Č‚Ē‚Ģd“Ä‚Č•›ģ—p‚Ŗ”­Œ»‚·‚é‚Ø‚»‚ź‚Ŗ‚ ‚邽‚߁CƒAƒvƒŒƒsƒ^ƒ“ƒg‚Ø‚ę‚ŃƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒg‚Ę‚Ģ•¹—p‚Ķ‹ÖŠõ‚Ę‚³‚ź‚Ä‚¢‚éB

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ƒfƒLƒTƒƒ^ƒ]ƒ“‚āƒvƒŒƒhƒjƒ]ƒƒ“‚Č‚Ē‚Ģ•›t”ēŽæƒXƒeƒƒCƒh‚ąCYP3A4 ‚É‚ę‚Į‚Ä‘ćŽÓ‚³‚ź‚éBƒAƒvƒŒƒsƒ^ƒ“ƒg•¹—pŽž‚É‚ĶƒfƒLƒTƒƒ^ƒ]ƒ“‚ĢAUC ‚Ŗ‘‰Į‚·‚é7j‚½‚߁CƒAƒvƒŒƒsƒ^ƒ“ƒg‚ą‚µ‚­‚ĶƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒg‚šŠÜ‚Ž§“f—Ć–@‚É‚Ø‚Æ‚éƒfƒLƒTƒƒ^ƒ]ƒ“‚Ķ‘ŠŒŻģ—p‚šl—¶‚µ‚½Œø—Ź‚É‚Ä“Š—^‚³‚ź‚éiØCQ5 ŽQĘjB‚Č‚ØCƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒg‚Ģ“Š—^‚Ķ1 “ś–Ś‚Ģ‚Ż‚Å‚ ‚邱‚Ę‚©‚ēCƒfƒLƒTƒƒ^ƒ]ƒ“‚Ę‚Ģ‘ŠŒŻģ—piAUC ‘‰Įj‚Ķ2 “ś–Ś‚Ü‚Å‚µ‚©”F‚ß‚ē‚ź‚Č‚¢8jBˆź•ūCR‚Ŗ‚ń–ņ‚Ę‚µ‚Ä“Š—^‚³‚ź‚é•›t”ēŽæƒXƒeƒƒCƒh‚ĶŒø—Ź‚³‚ź‚é‚ׂ«‚Å‚Ķ‚Č‚¢B‚Č‚ØCR-CHOP —Ć–@‚É‚Ø‚Æ‚éƒvƒŒƒhƒjƒ]ƒƒ“‚ĢAUC ‚ĶƒAƒvƒŒƒsƒ^ƒ“ƒg•¹—p‚É‚ę‚č‰e‹æ‚šŽó‚Æ‚Č‚¢‚±‚Ę‚Ŗ•ń‚³‚ź‚Ä‚¢‚é9jB

R‚Ŗ‚ń–ņˆČŠO‚Å‚ĶCCYP3A4 ‚Å‘ćŽÓ‚³‚ź‚éƒ~ƒ_ƒ]ƒ‰ƒ€i2 mgj‚ĢAUC ‚ŖƒAƒvƒŒƒsƒ^ƒ“ƒg‚Ø‚ę‚ŃƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒg•¹—p‚É‚ę‚č‘‰Į‚·‚邱‚Ę‚Ŗ•ń‚³‚ź‚Ä‚¢‚é8j10jBƒƒ‹ƒtƒ@ƒŠƒ“‚ĶƒAƒvƒŒƒsƒ^ƒ“ƒg‚ĢCYP2C9 —U“±ģ—p‚É‚ę‚čCS-ƒƒ‹ƒtƒ@ƒŠƒ“‚ĢŒŒ’†”Z“x‚Ŗ’į‰ŗ‚µ‚čR‹ĆŒÅģ—p‚ŖŒøŽć‚·‚é11j‚½‚߁Cƒƒ‹ƒtƒ@ƒŠƒ““Š—^Š³ŽŅ‚ɃAƒvƒŒƒsƒ^ƒ“ƒg‚āƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒg‚š“Š—^‚·‚éŪ‚Ķƒvƒƒgƒƒ“ƒrƒ“ŽžŠŌiPT-INRj‚Ģƒ‚ƒjƒ^ƒŠƒ“ƒO‚š–§‚ɍs‚¤B“Æ‚¶‚­CYP2C9 ‚Å‘ćŽÓ‚³‚ź‚éƒgƒ‹ƒuƒ^ƒ~ƒhi500 mgj‚ąƒAƒvƒŒƒsƒ^ƒ“ƒg•¹—p‚É‚ę‚čAUC ‚Ŗ’į‰ŗ‚·‚é10jB

ˆź•ūCƒAƒvƒŒƒsƒ^ƒ“ƒg‚āƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒg‚Ģ AUC ‚ɉe‹æ‚š—^‚¦‚é–ņÜ‚Ŗ‚ ‚éBCYP3A4 ‚Ģ‘jŠQ–ņ‚Å‚ ‚éƒCƒgƒ‰ƒRƒiƒ][ƒ‹‚Č‚Ē‚ĢƒAƒ][ƒ‹ŒnR^‹Ū–ņ‚āƒNƒ‰ƒŠƒXƒƒ}ƒCƒVƒ“‚Č‚Ē‚Ģƒ}ƒNƒƒ‰ƒCƒhŒnR‹Ū–ņ‚ĶƒAƒvƒŒƒsƒ^ƒ“ƒg‚Ģ AUC ‚š‘‰Į‚³‚¹‚éB‚Ü‚½CYP3A4 ‚Ģ—U“±–ņ‚Å‚ ‚éƒJƒ‹ƒoƒ}ƒ[ƒsƒ“CƒŠƒtƒ@ƒ“ƒsƒVƒ“CƒtƒFƒjƒgƒCƒ“‚ĶƒAƒvƒŒƒsƒ^ƒ“ƒg‚ĢAUC ‚š’į‰ŗ‚³‚¹‚éB‚µ‚½‚Ŗ‚Į‚āC‚±‚ź‚ē‚Ę‚Ģ•¹—pŽž‚É‚ĶƒAƒvƒŒƒsƒ^ƒ“ƒg‚āƒzƒXƒAƒvƒŒƒsƒ^ƒ“ƒg‚ĢŒų‰Ź‚Ŗ‘‹­‚ą‚µ‚­‚ĶŒøŽć‚·‚é‰Ā”\«‚Ŗ‚ ‚éB

+ ŽQl‚É‚µ‚½“ńŽŸŽ‘—æ
  1. NCCN Clinical Practice Guidelines in Oncology-Antiemesis-ver. 2, 2017
  2. Kris MG, Hesketh PJ, Somerfield MR, et al. American Society of Clinical Oncology Guideline for antiemetics in Oncology: Update 2006. J Clin Oncol. 2006; 18: 2932-47.
  3. 2017 UpToDate Version 78.0gPrevention and treatment of chemotherapy-induced nausea and vomiting in adultsh
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i jƒGƒrƒfƒ“ƒXƒŒƒxƒ‹

1jNygren P, Hande K, Petty KJ, et al. Lack of effect of aprepitant on the pharmacokinetics of docetaxel in cancer patients. Cancer Chemother Pharmacol. 2005; 55: 609-16.

iⅡ j

2jLoos WJ, de Wit R, Freedman SJ, et al. Aprepitant when added to a standard antiemetic regimen consisting of ondansetron and dexamethasone does not affect vinorelbine pharmacokinetics in cancer patients. Cancer Chemother Pharmacol. 2007; 59: 407-12.

iIIIj

3jSarantopoulos J, Mita AC, Wade JL, et al. Phase I study of cabazitaxel plus cisplatin in patients with advanced solid tumors: study to evaluate the impact of cytochrome P450 3A inhibitorsiaprepitant, ketoconazolejor inducersirifampinjon the pharmacokinetics of cabazitaxel. Cancer Chemother Pharmacol. 2014; 74: 1113-24.

iIIIj

4jBubalo JS, Cherala G, McCune JS, et al. Aprepitant pharmacokinetics and assessing the impact of aprepitant on cyclophosphamide metabolism in cancer patients undergoing hematopoietic stem cell transplantation. J Clin Pharmacol. 2012; 52: 586-94.

iⅡ j

5jWalko CM, Combest AJ, Spasojevic I, et al. The effect of aprepitant and race on the pharmacokinetics of cyclophosphamide in breast cancer patients. Cancer Chemother Pharmacol. 2012; 69: 1189-96.

iⅡ j

6jWarr DG, Hesketh PJ, GrallaRJ, et al. Efficacy and tolerability of aprepitant for the prevention of chemotherapy-induced nausea and vomiting in patients with breast cancer after moderately emetogenic chemotherapy. J Clin Oncol. 2005; 23: 2822-30.

iⅡ j

7jMcCrea JB, Majumdar AK, Goldberg MR, et al. Effects of the neurokinin1 receptor antagonist aprepitant on the pharmacokinetics of dexamethasone and methylprednisolone. Clin Pharmacol Ther. 2003; 74: 17-24.

iⅡ j

8jMarbury TC, Ngo PI, Shadle CR, et al. Pharmacokinetics of oral dexamethasone and midazolam when administered with single-dose intravenous 150 mg fosaprepitant in healthy adult subjects. J Clin Pharmacol. 2011; 51: 1712-20.

iⅡ j

9jMaie K, Okoshi Y, Takaiwa N, et al. Aprepitant does not alter prednisolone pharmacokinetics in patients treated with R-CHOP. Ann Oncol. 2014; 25: 298-9.

iIIIj

10jShadle CR, Lee Y, Majumdar AK, et al. Evaluation of potential inductive effects of aprepitant on cytochrome P450 3A4 and 2C9 activity. J Clin Pharmacol. 2004; 44: 215-23.

iⅡ j

11jDepré M, Van Hecken A, Oeyen M, et al. Effect of aprepitant on the pharmacokinetics and pharmacodynamics of warfarin. Eur J Clin Pharmacol. 2005; 61: 341-6.

iⅡ j


Clinical QuestionE„§ˆź——‚Ö


CQ18
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—\–h“I§“f—Ć–@’†‚ɐ¶‚¶‚½ˆ«SEšq“f‚É‘Ī‚µ‚Ä‚ĶCƒIƒsƒIƒCƒhˆČŠO‚ɍl‚¦‚ē‚ź‚é—vˆö‚šCQ15 ‚šŽQĘ‚µ‚Ā‚ĀœŠO‚µCƒIƒsƒIƒCƒh‚ĢŒø—ŹC“Š—^ƒ‹[ƒg‚Ģ•ĻXC•ŹŒn“‚ĢƒIƒsƒIƒCƒh‚Ö‚Ģ•ĻX‚šl—¶‚·‚éB‚»‚Ģ‚¤‚¦‚Å“K‰ž‚Ŗ‚ ‚ź‚ĪCƒIƒ“ƒ_ƒ“ƒZƒgƒƒ“‚š—p‚¢‚éB”ń‚Ŗ‚ńįu’É‚É‘Ī‚·‚éƒIƒsƒIƒCƒh‚Ģˆ«SEšq“f‚É‘Ī‚µCƒvƒ‰ƒZƒ{‚š‘ĪŪ‚Ę‚µ‚½ƒIƒ“ƒ_ƒ“ƒZƒgƒƒ“‚ĢPONV ‚É‘Ī‚·‚éŒų‰Ź‚Ŗƒƒ^ƒAƒiƒŠƒVƒX‚Å‚ą”F‚ß‚ē‚ź‚Ä‚¢‚邱‚Ę5jCpŒć‚ɃIƒsƒIƒCƒh‚š—p‚¢‚éŪCƒIƒ“ƒ_ƒ“ƒZƒgƒƒ“‚ŖƒƒgƒNƒƒvƒ‰ƒ~ƒh‚É”ä‚א§“fŒų‰Ź‚ŏŸ‚Į‚Ä‚¢‚½‚±‚Ę6j‚Ŗ‚»‚ĢŖ‹’‚Ę‚Č‚éBis‚µ‚½ŽžŠś‚Ģ‚Ŗ‚ńŠ³ŽŅ‚ŁCƒIƒsƒIƒCƒh‚É”ŗ‚¤‚ą‚Ģ‚ąŠÜ‚Ü‚ź‚é“ļŽ”«ˆ«SEšq“f‚É‘Ī‚µ‚āCƒIƒ‰ƒ“ƒUƒsƒ“CƒŠƒXƒyƒŠƒhƒ“CƒNƒƒ‹ƒvƒƒ}ƒWƒ“CƒNƒƒ‹ƒtƒFƒjƒ‰ƒ~ƒ“‚Ŗ‚ ‚éB‚½‚¾‚µC‚»‚ź‚ē‚Ģ—LŒų«‚šŽ¦“‚·‚éƒGƒrƒfƒ“ƒX‚Ķ­”—į‚Ģ‘ęⅡ ‘ŠŽŽŒ±‚É‚Ę‚Ē‚Ü‚Į‚Ä‚¢‚éB

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“Š—^ƒ‹[ƒg•ĻX‚É‚Ā‚¢‚Ä‚ąŽæ‚Ģ‚‚¢ƒ‰ƒ“ƒ_ƒ€‰»”äŠrŽŽŒ±‚Ķ‚Č‚¢B’†‹K–Ķ‚Ģ‘OŒć”äŠrŒ¤‹†‚Å‚ĶCƒ‚ƒ‹ƒqƒl‚ĢŒoŒū‚©‚ēŒoĆ–¬EŒo”ē‰ŗƒ‹[ƒg‚ցCŒo”ēƒtƒFƒ“ƒ^ƒjƒ‹‚šƒ‚ƒ‹ƒqƒl‚Č‚¢‚µƒtƒFƒ“ƒ^ƒjƒ‹‚ĢŒoĆ–¬EŒo”ē‰ŗƒ‹[ƒg‚Ö‚Ģ•ĻX‚ň«SEšq“f‚ĢŒyŒø‚š”F‚ß‚Ä‚¢‚é9j10jB

+ ŽQl‚É‚µ‚½“ńŽŸŽ‘—æ
  1. “ś–{ŠÉ˜aˆć—ĆŠw‰ļ•ŅD‚Ŗ‚ńįu’É‚Ģ–ņ•Ø—Ć–@‚ÉŠÖ‚·‚éƒKƒCƒhƒ‰ƒCƒ“@2014 ”N”ŁD‹ąŒ“o”ŁC“Œ‹žC2014D
  2. “ś–{–ƒŒ‰ČŠw‰ļD–ƒŒ–ņ‚Ø‚ę‚Ń–ƒŒŠÖ˜A–ņŽg—pƒKƒCƒhƒ‰ƒCƒ“@‘ę3 ”ŁD2015D
  3. Caraceni A, Hanks G, Kaasa S, et al. Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol. 2012; 13: e58-68.
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i jƒGƒrƒfƒ“ƒXƒŒƒxƒ‹

1j Wiffen PJ, Derry S, Moore RA. Impact of morphine, fentanyl, oxycodone or codeine on patient consciousness, appetite and thirst when used to treat cancer pain. Cochrane Database Syst Rev. 2014; 5: CD011056.

iⅠ j

2j Gan TJ, Diemunsch P, Habib AS, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014; 118: 85-113.

 

3j Hardy J, Daly S, McQuade B, et al. A double-blind, randomized, parallel group, multinational, multicentre study comparing a single dose of ondansetron 24 mg p.@o. with placebo and metoclopramide 10 mg t.@d.@s.@p.@o. in the treatment of opioid-induced nausea and emesis in cancer patients. Support Care Cancer. 2002; 10: 231-6.

iⅡ j

4j Tsukuura H, Miyazaki M, Morita T, et al. Efficacy of Prophylactic Treatment for Oxycodone-Induced Nausea and Vomiting Among Patients with Cancer Pain (POINT): A Randomized, Placebo-Controlled, Double-Blind Trial. Oncologist. 2017 Oct 16.[Epub ahead of print]

5j Tramè r MR, Reynolds DJ, Moore RA, et al. Efficacy, dose-response, and safety of ondansetron in prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized placebo-controlled trials. Anesthesiology. 1997; 87: 1277-89.

iⅠ j

6j Chung F, Lane R, Spraggs C, et al. Ondansetron is more effective than metoclopramide for the treatment of opioid-induced emesis in post-surgical adult patients. Ondansetron OIE Post-Surgical Study Group. Eur J Anaesthesiol. 1999; 16: 669-77.

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7j Narabayashi M, Saijo Y, Takenoshita S, et al. Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable adverse effects: an open-label trial. Jpn J Clin Oncol. 2008; 38: 296-304.

iIIIj

8j Mercadante S, Bruera E. Opioid switching: a systematic and critical review. Cancer Treat Rev. 2006; 32: 304-15.

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9j Hunt R, Fazekas B, Thorne D, et al. A comparison of subcutaneous morphine and fentanyl in hospice cancer patients. J Pain Symptom Manage. 1999; 18: 111-9.

iⅡ j

10j Enting RH, Oldenmenger WH, van der Rijt CC, et al. A prospective study evaluating the response of patients with unrelieved cancer pain to parenteral opioids. Cancer. 2002; 94: 3049-56.

iIIIj


Clinical QuestionE„§ˆź——‚Ö


Appendix@§“f–ņ‚Ģ•›ģ—p

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1j ˆć–ņ•i“Y•t•¶‘

 

2j Siddiqui MA, Scott LJ. Palonosetron. Drugs. 2004; 64: 1125-32.

 

3j Dando TM, Perry CM. Aprepitant: a review of its use in the prevention of chemotherapy-induced nausea and vomiting. Drugs. 2004; 64: 777-94.

 

4j dos Santos LV, Souza FH, Brunetto AT, et al. Neurokinin-1 receptor antagonists for chemotherapy-induced nausea and vomiting: a systematic review. J Natl Cancer Inst. 2012; 104: 1280-92.

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Clinical QuestionE„§ˆź——‚Ö