2016 年 42 巻 3 号 p. 185-192
Although mFOLFOX6 and FOLFIRI are both categorized as moderately emetogenic chemotherapies, they may have a different prevalence of chemotherapy-induced nausea and vomiting (CINV). The optimal strategy to prevent CINV remains uncertain when patients receive mFOLFOX6 followed by FOLFIRI. Of 100 clinical cases executed with mFOLFOX6 and FOLFIRI, we retrospectively investigated the contents of prophylactic antiemetic therapy and the incidence of CINV, and evaluated the efficacy of them when the regimen was changed. Addition of aprepitant, change of 5-HT3RA to panolosetron, or an increase of the dose of dexamethasone are defined as the intensification of the prophylactic antiemetic therapy (IAT). Around a half of patients who experienced CINV in mFOLFOX6 had intensified prophylactic antiemetic therapy, but over 60％ of them experienced CINV even in FOLFIRI. In order to clearly evaluate the efficacy of IAT, patients were divided into a guideline non-adherent group in which dexamethasone was administered only on Day 1, and a guideline adherent group in which dexamethasone was administered for 3 or 4 days after chemotherapy. Without IAT, the incidence of CINV was significantly increased only by changing chemotherapy from mFOLFOX6 to FOLFIRI (30.8%, 47.6%, respectively, P = 0.048). The incidence of CINV was significantly lower in the guideline adherent group than in the guideline non-adherent group when antiemetic therapy was intensified (25.0%, 81.8%, respectively, P = 0.024). These findings suggest the necessity of IAT and the importance of adhering to the antiemetic guideline concerning the period of dexamethasone administration in patients who receive mFOLFOX6 followed by FOLFIRI.
