Prospective Clinical Study Of Thalidomide,Medroxyprogesterone Combined With Ondansetron In The Prevention And Treatment Of Gastrointestinal Toxicity Induced By Chemotherapy

According to the latest data released by the National Cancer Center in January 2019,the incidence of cancer and mortality have gradually increased in the past decade,of which the national cancer incidence rate is285.83/100,000,with the number of 3.929 million cases,and the mortality rate is 170.05/100,000,with the number of 2.338 million cases,in 2015.According to the statistics,nearly RMB 220 billion medical expenses are used in the treatment of malignant tumors in China annually.Although there are more and more methods of cancer treatment owing to the development of science and technology in medicine,chemotherapy is still an irreplaceable important treatment.Antitumor drugs could kill the tumor cells in the body,but at the same time act on the normal tissues and organs,thus triggering multiple systemic side effects.Among them,the toxicity of digestive tract is the most common.More than 90% of patients with chemotherapy have shown different degrees of gastrointestinal discomfort,which seriously affects the quality of life and treatment compliance of chemotherapy patients.The side effects of chemotherapy are the main factors limiting the application of chemotherapy,and the specific mechanism is complicated.Close attention,active treatment and prevention are all required in clinical work.At present,the drugs for the treatment of gastrointestinal adverse reactions mainly include 5-HT₃ receptor antagonists,glucocorticoids,NK-1 receptor antagonists,psychotropic drugs,opioids drugs and anticholinergics,etc.The therapeutic effect and control rate of acute gastrointestinal side effects caused by chemotherapy are considerable,but the therapeutic effect of delayed gastrointestinal side effects is still not satisfied.Some new drugs,such as Aprepitant,have better theraputic effect,but also exist some problems like high price and poor drug accessibility.It is necessary to explore a cost-effective adjuvant treatment strategy to improve the control rate of gastrointestinal toxic and side effects in patients with clinical chemotherapy,thus ensuring the complete chemotherapy according to the scheduled program,improving the control rate of malignant tumors,and reducing the risk of insufficient nutrition intake in tumor patients with chemotherapy.A number of clinical studies have confirmed that thalidomide and medroxyprogesterone can effectively improve the nutritional status and physical status of patients,with low price and high safety,and the clinical application is common.Objective:In order to seek a more cost-effective treatment for the prevention and treatment of gastrointestinal side effects,provide a new idea for the clinical treatment of gastrointestinal toxic side effects,and improve the compliance and prognosis of patient with chemotherapy,we observe and analyze the efficacy and safety of thalidomide,medroxyprogesterone combined with ondansetron injection in the prevention and treatment of gastrointestinal side effects caused by chemotherapy.Methods:From November 2017 to June 2018,100 patients with chemotherapy were selected from the Radiotherapy and Chemotherapy Center of Chengde Central Hospital,the chemotherapy regimen contained medium and high vomiting chemotherapy drugs.The patients were divided in to observation group?n=50?and control group?n=50?according to the stratified random numerical table method.The patients in the observation group were given ondansetron injection 8mg 30 minutes before chemotherapy,4 hours after chemotherapy,8 hours after chemotherapy,2-5 days after chemotherapy.Ondansetron injection 8 mg,twice daily intravenous injection.On day 1-5,50mg thalidomide and 250 mg medroxyprogesterone were given twice daily,in the control group,ondansetron injection was used alone,the usage and dosage are the same as those of the observation group.According to CTCAE standard?see Table 1?,the incidence and degree of gastrointestinal toxicity induced by chemotherapy in the two groups were evaluated and the safety analysis was made.The database was established by Excel software and analyzed by SPSS 21.0 software.The comparison of the two groups of data rates was performed by ?² test,the comparison of the two groups of measurement data was performed by two independent samples t test,the dependent variable was compared with the level data using Wilcoxon rank sum test.The statistical test level was?=0.05.Results:1 There was no significant difference in sex,age,ECOG score and the proportion of emetic distribution in the chemotherapy regimen between the observation group and the control group?P>0 05?.The distribution between the two groups was balance and comparable.2 The incidence of acute nausea and acute vomiting were lower in the observation group and the control group,the difference was not statistically significant?P>0.05?.The incidence of abdominal distension in the two groups was higher,56%of patients had different degrees of abdominal distension during chemotherapy.There was no significant difference between the observation group and the control group?P>0.05?.3 The incidence of delayed nausea was 24%in the observation group and44%in the control group.The difference between the two groups was statistically significant?P<0.05?.The incidence of delayed vomiting was 12%in the observation group and 30%in the control group.The difference between the two groups was statistically significant?P<0.05?.Both the incidence and degree of delayed nausea and vomiting in the observation group were lower than the control group.4 The incidence of loss of appetite was 44%in the observation group and68%in the control group.The difference between the two groups was statistically significant?P<0.05?.The incidence of diarrhea was 26%in the observation group and 42%in the control group.The difference between the two groups was statistically significant?P<0.05?.The incidence and extent of loss of appetite and diarrhea in the observation group were lower than those in the control group.5 After the two groups of chemotherapy patients were treated with different treatments,the side effects of adjunct drugs were mild and tolerable,and they could relieve themselves after discontinuation.The incidence of adverse reactions in the observation group:fatigue 26%,constipation 46%,erythra 6%.The incidence of adverse reactions in the control group:fatigue34%,constipation 38%,erythra 2%,the difference between the two groups was not statistically significant?P>0.05?.One patient in the control group developed intermuscular vein thrombosis in the left upper limb.Conclusion:1 Thalidomide,medroxyprogesterone combined with ondansetron can effectively alleviate the incidence and degree of diarrhea,loss of appetite,delayed nausea and delayed vomiting in patient with chemotherapy.The combined regimen of three drugs is superior to ondansetron alone in the treatment of gastrointestinal toxicity and side effects.In the treatment of acute nausea,acute vomiting and abdominal distension,the two treatment regimens have the same effect.2 The combination of thalidomide,medroxyprogesterone combined with ondansetron was effective in the treatment of gastrointestinal toxicity and side effects of patient with chemotherapy,which did not increase the risk of drug-related adverse reactions such as fatigue,constipation,thrombosis,erythra,etc.The combination of the three drugs was safe and reliable.