Clinical Observation Of Comparison Of Promethazine And Aprepitant In Prevention Of Nausea And Vomiting Induced By Docetaxel Combined With Cisplatin

ObjectiveTo observe and compare the therapeutic effects,adverse reactions and impacts on the quality of patients’ life of promethazine and aprepitant when they are used in prevention of nausea and vomiting induced by the chemotherapy prot ocol combined docetaxel with cisplatin.MethodsSelect 82 patients with malignant solid tumors who received the chemotherapy protocol combined docetaxel with cisplatin from October 2016 to October 2018 in our hospital,including 30 cases of lung cancer,20 cases of cervical cancer,15 cases of ovarian cancer and 17 cases of esophageal cancer.The patients were grouped based on the random number table method.There were 40 cases in the observation group(promethazine group),in which the antiemetic scheme was as follow: promethazine(25mg im d1-d3),palonosetron(0.25 mg iv d1,d3),and dexamethasone(8mg po bid d0-d2,8mg po qd d3).42 cases in the control group(aprepitant group)were treated with aprepitant(120mg po d1、 80 mg po d2-d3),palonosetron(0.25 mg iv d1,d3),and dexamethasone(8mg po bid d0-d2,8mg po qd d3).The primary study endpoint was the percentage of patients who had a complete remission(CR,refers to no nausea and vomiting without using rescue medications)during overall phase(0~120 hours after chemotherapy),acute phase(0~24 hours after chemotherapy)and delay phase(24~120 hours after chemotherapy).The secondary study endpoints were the occurrence of adverse reactions and the evaluation on quality improvement of patients’ life.Results1 During the overall phase,CRR of nausea and vomiting in promethazine group and aprepitant group were 65.0%(26/40)and 69.0%(29/42),respectively.The CRR of the two groups was of no significant difference(P=0.697).2 During the acute phase,CRR of nausea and vomiting in promethazine group and aprepitant group were 85.0%(34/40)and 88.1%(37/42),respectively.There was no significant difference between the two groups(P=0.681).3 During the delay phase,CRR of nausea and vomiting in promethazine group and aprepitant group were 67.5%(27/40)and 73.8%(31/42),respectively,showing no statistical difference between the two groups(P=0.530).4 In terms of treatment safety,the side effect of constipation in promethazine group was lower than that in aprepitant group(P=0.029).However,the side effects of dizziness and sleepiness in promethazine group were higher compared with the aprepitant group(P values were 0.018 and 0.000 respectively),There were no adverse reactions of grade III ~IV in both groups.And the two group are tolerant on side effects.5 Functional Living Index-Emesis(FLIE)scores in promethazine group and aprepitant group were106.23±9.47、110.19±7.92,respectively.The difference between the two groups was statistically significant(P=0.043).Conclusions1 Promethazine combined with palonosetron and dexamethasone is effective in preventing nausea and vomiting induced by hyperemetic chemotherapy.2 The antiemetic effects of promethazine group and aprepitant group are si milar.Promethazine group is also tolerant on the side effects.3 Compared with aprepitant group,the quality of patient’s life in prometha zine group was slightly lower.But it is acceptable for most patients to reduce recreational or leisure activities,housework,and gatherings with relatives and frie nds to alleviate the psychological pressure of chemotherapy.4 Compared with aprepitant,promethazine has a low price and is available in hospitals.Within the scope of medical insurance,it is worth promoting in poor areas or areas where aprepitant is not covered by medical insurance.