Реальные надежды в антиэметической терапии

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.

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