Efficacy And Safety Of NK-1 Receptor Antagonist Combined With 5-HT₃ Receptor Antagonist And Dexamethasone For The Prevention Of Chemotherapy-induced Nausea And Vomiting For Breast Cancer:a Meta-analysis

ObjectiveThe aim of this study was to determine the efficacy and safety of the addition of neurokinin-1?NK-1?receptor antagonist to 5-hydroxytryptamine 3?5-HT₃?receptor antagonist combined with dexamethasone for the prevention of anthracyclines-cyclophosphamide-based chemotherapy-induced nausea and vomiting.MethodsA systematic literature search was performed using the PubMed,Cochrane Library,Google Scholar,CBM,Wan Fang,Vip and ASCO meeting abstracts from inception to December 2018.We collected randomized controlled trials?RCTs?about the addition of NK-1 receptor antagonist combined with 5-HT₃ receptor antagonist and dexamethasone?test group?versus dexamethasone combined with 5-HT₃ receptor antagonist?control group?for anthracyclines-cyclophosphamide-based chemotherapy-induced nausea and vomiting.We evaluated quality of eligible trials by using Cochrane risk of bias tool.After data extraction,we used RevMan 5.3 statistical software to perform the Meta-analysis for complete response?CR?rate in overall,acute and delayed phase and the incidence of adverse event?fatigue,headache,constipation,diarrhea,anorexia?.Statistical heterogeneity among the studies was evaluated with Q test and I² statistic.At the same time,a funnel plot was used to assess reporting bias.ResultsSeven RCTs met eligibility criteria that include totally 5503 patients,3227 in test group and 2276 in control group.The funnel plot suggested that the study bias was not significant.Results of Meta-analysis showed that CR rate in overall phase[OR=0.63,95%CI?0.56,0.71?,P<0.0001],acute phase[OR=0.76,95%CI?0.66,0.88?,P=0.0002]and delayed phase[OR=0.64,95%CI?0.57,0.72?,P<0.0001]in test group were higher than control group,with statistical significance.As for the adverse event,fatigue incidence was higher in control group[OR 1.50,95%CI?1.20,1.88?,P=0.009].There was no statistical significance between 2 groups in the occurrence of headache,constipation,anorexia,diarrhea?P>0.05?.ConclusionsNK-1 receptor antagonist combined with 5-HT₃ receptor antagonist and dexamethasone could prevent nausea and vomiting induced by anthracyclines-cyclophosphamide-based chemotherapy.It is better than 5-HT₃ receptor antagonist combined with dexamethasone in improving CR rate in overall,acute and delayed phase,and it is well-tolerated.