References

medsovet

Медицинский Совет

Meditsinskiy sovet = Medical Council

2079-701X2658-5790

REMEDIUM GROUP Ltd.

10.21518/ms2024-194

medsovet-8402

Research Article

ПОДДЕРЖИВАЮЩАЯ ТЕРАПИЯ

SUPPORTIVE THERAPY

Реальные надежды в антиэметической терапии

Real hopes in antiemetic therapy

https://orcid.org/0000-0003-3326-4961

Когония

Л. М.

Kogoniya

L. М.

Когония Лали Михайловна - д.м.н., профессор, профессор кафедры онкологии и торакальной хирургии факультета усовершенствования врачей.

129110, Москва, ул. Щепкина, д. 61/2, корп. 1

Lali М. Kogoniya - Dr. Sci. (Med.), Professor, Professor of the Department of Oncology and Thoracic Surgery of the Faculty of Advanced Medical Education.

61/2, Bldg. 1, Schepkin St., Moscow, 129110

lali51@yandex.ru

Московский областной научно-исследовательский клинический институт имени М.Ф. ВладимирскогоРоссияMoscow Regional Research Clinical Institute named after M.F. VladimirskyRussian Federation

2024

25072024

010117123

2024

Когония Л.М.

Kogoniya L.М.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.med-sovet.pro/jour/article/view/8402

Лекарственная противоопухолевая терапия достигла значительных успехов в последние два десятилетия. Однако особого внимания требует коррекция нежелательных явлений и осложнений, возникающих в процессе лечения. Наиболее часто специальная противоопухолевая терапия может вызывать побочные явления со стороны желудочного-кишечного тракта. Химиоиндуцированная тошнота и рвота является наиболее частым нежелательным явлением при лекарственной терапии рака. Она значительно ухудшает самочувствие и качество жизни больных. При многократных циклах химиотерапии могут возникать эпизоды как острой, так и отсроченной тошноты/рвоты. Существует несколько фармакологических групп противорвотных средств. Наиболее эффективным режимом для профилактики химиоиндуцированной тошноты и рвоты является комбинация антагонистов серотониновых рецепторов (5-НТ3) и нейрокининовых рецепторов (NK-1). Она обеспечивает высокий контроль симптомов как в острой, так и в отсроченной фазе тошноты/рвоты. Палоносетрон, антагонист серотониновых рецепторов нового поколения, отличается от антагонистов 5-НТ3-рецепторов первого поколения более сильным и продолжительным противорвотным эффектом при сопоставимом профиле безопасности. Пероральный прием палоносетрона не уступает по эффективности его внутривенному введению. Комбинированный пероральный препарат, включающий в себя антагонист NK-1 нетупитант и антагонист 5-НТ3 палоносетрон, высокоэффективен для профилактики тошноты и рвоты при умереннои высокоэметогенных режимах лекарственной терапии. Длительный период полувыведения обоих препаратов и их высокое сродство к соответствующим рецепторам обеспечивают продолжительный и стойкий эффект даже при однократном приеме. Особенно эффективно с помощью этой комбинации купируются симптомы отсроченной тошноты/рвоты. Ряд клинических исследований продемонстрировал, что однократный пероральный прием комбинированного препарата нетупитант/палоносетрон достоверно более эффективен, чем трехдневные режимы на основе апрепитанта, в плане предотвращения отсроченной химиоиндуцированной тошноты и рвоты. Кроме того, применение комбинации нетупитант/палоносетрон может быть экономически выгодным за счет снижения затрат на коррекцию осложнений плохо контролируемой тошноты и рвоты.

Anticancer drug therapy has made significant progress in the last two decades. However, the correction of adverse events and complications that arise during treatment requires special attention. Most often, special antitumor therapy can cause side effects from the gastrointestinal tract. Chemo-induced nausea and vomiting is the most common adverse event associated with drug therapy of cancer. It significantly worsens the well-being and quality of life of patients. With multiple cycles of chemotherapy, episodes of both acute and delayed nausea/vomiting may occur. There are several pharmacological groups of antiemetics. The most effective regimen for the prevention of chemotherapy-induced nausea and vomiting is a combination of serotonin receptor (5-HT3) and neurokinin receptor (NK-1) antagonists. It provides high symptom control in both the acute and delayed phases of nausea/vomiting. Palonosetron, a new-generation serotonin receptor antagonist, differs from firstgeneration 5-HT3 receptor antagonists in its stronger and longer-lasting antiemetic effect with a comparable safety profile. Oral administration of palonosetron is not inferior in effectiveness to its intravenous administration. An oral combination drug containing the NK-1 antagonist netupitant and the 5-HT3 antagonist palonosetron is highly effective in preventing nausea and vomiting in moderately and highly emetogenic drug regimens. The long half-life of both drugs and their high affinity to their receptors provide a long-lasting and persistent effect even with a single dose. This combination is particularly effective in relieving symptoms of delayed nausea/vomiting. A number of clinical studies have demonstrated that a single oral dose of netupitant/palonosetron combination is significantly more effective than 3-day aprepitant-based regimens in preventing delayed chemotherapy-induced nausea and vomiting. In addition, the netupitant/palonosetron combination may be cost-effective by reducing the cost of managing of complications of poorly controlled nausea and vomiting.

поддерживающая терапияхимиотерапиялекарственная терапиятошнотарвотаантиэметикипалоносетроннетупитанткачество жизни

maintenance therapychemotherapydrug therapynauseavomitingantiemeticspalonosetronnetupitantquality of life

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The authors declare that there are no conflicts of interest present.