Efficacy Of Mirtazapine Combined With Palonosetron And Aprepitant In The Prevention Of Chemotherapy-induced Nausea And Vomiting Following Highly Emetogenic Chemotherapy

BackgroundChemotherapy induced nausea and vomiting(CINV)is the most common side effect of chemotherapy for malignant tumors.To prevent highly emetogenic chemotherapy,CINV guidelines recommend the use of a combination of multiple drugs,which include dexamethasone.As we all know,dexamethasone,as a steroid hormone,not only leads to insulin resistance,but also plays an important role in the occurrence and development of tumor.In recent years,with the establishment of "bio-psycho-social medical model",olanzapine,a new antipsychotic drug,has been recommended by the guidelines for the prevention of CINV,and it has been pointed out that olanzapine can be used instead of dexamethasone when patients cannot tolerate steroid drugs.However,olanzapine as an antipsychotic drug,inevitably brings mental and psychological burden to patients during the period of CINV prevention(fear of antipsychotic drug use),and its side effects are obvious.As an antidepressant,mirtazapine has the functions of anti anxiety,improving sleep and appetite,and it has high safety.Previous studies have shown its antiemetic effect.In this study,we used mirtazapine instead of dexamethasone and olanzapine in combination with palonosetron and aprepitant to observe the antiemetic effect.Objective1.Main objective:To observe the efficacy and safety of mirtazapine in the prevention of nausea and vomiting caused by highly emetogenic chemotherapy;2.Secondary objective:To study the relationship between anxiety,depression and CINV,and the changes in sleep.MethodsFrom June 2018 to February 2020,52 patients with malignant tumor who received high emetic chemotherapy were included in the First Affiliated Hospital of Xinxiang Medical College,was given a triple antiemetic regimen:d1:palonosetron,0.25 mg,iv +aprepitant,125 mg,po+mirtazapine,15 mg,po;d2-3:aprepitant,80 mg,po+mirtazapine,15 mg,po;d4-5:mirtazapine,15 mg,po.From the day of chemotherapy,the degree of nausea was evaluated with VAS score table,and the frequency and time of vomiting were recorded in detail until the 5th day after chemotherapy.According to the corresponding standards,the complete response rate and effective control rate of nausea and vomiting were calculated respectively in the acute period,the delayed period and the overall observation period.According to the scores of nausea and vomiting,the patients were divided into nausea group and no nausea group;vomiting group and no vomiting group.Before and after treatment,SAS and SDS were used to evaluate the anxiety and depression status of all patients,and the differences between anxiety and depression scores in each two groups and their relationship with CINV were statistically analyzed.GSDS was used to evaluate the improvement of sleep quality before and after treatment.Adverse drug events were recorded in detail during the study,and were evaluated according to the classification of adverse events according to CTC-AE4.03.Results1.The CR of nausea was 67.3%,51.9% and 44.2% in the acute,delayed and total observation periods,the CR of vomiting was 96.2%,82.7%,80.8%.The effective control rates of nausea and vomiting were 80.8% and 90.4% during the overall period.2.The scores of anxiety and depression in the group with nausea were higher than that in the group without nausea,the difference was statistically significant(P?0.05);The scores of anxiety and depression in the group with vomiting were higher than that in the group without vomiting,the difference was statistically significant(P?0.05).Spearman correlation analysis showed that anxiety and depression scores were positively correlated Methods with nausea and vomiting(P?0.05).3.57.7% of the subjects had different sleep improvement,and no serious adverse side events were found in the observation period.Conclusion1.Mirtazapine can effectively prevent chemotherapy induced nausea and vomiting.2.Anxiety and depression are relevant factors in the occurrence of CINV.In addition to antiemetic drugs,psychoactive drugs and psychological intervention are also important means to prevent CINV.3.Mirtazapine can improve the sleep quality of patients,and the incidence of adverse events is low.