Li_2017
Supportive Therapie · Version 2.1
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Referenz (Autor, Jahr, Journal) |
Studientyp Mono- vs. Multizentrisch, Verblindung, Randomisierung, Arme, Fallzahl n, Land, Zeitraum
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Patienten-merkmale Indikation, Alter, Geschlecht (m/w) |
Intervention Fallzahl n, Beschreibung der präventiven bzw. therapeutischen Maßnahme |
Kontrolle Fallzahl n, Beschreibung der präventiven Maßnahme bzw. therapeutischen Maßnahme |
Zielgrößen Primärer Endpunkt Sekundäre(r) Endpunkt(e) |
Primärer Endpunkt Angaben für Intervention vs. Kontrolle |
Sekundäre(r) Endpunkt(e) Angaben für Intervention vs. Kontrolle |
Finanzierung |
Evidenzstufe Bei Abwertung: Angabe von Gründen Bewertung des Autors |
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Li
2017
Ann Palliat Med
Sicher et al. 1968 Stryker et al. 1979 Lucraft et al. 1982 Collis et al. 1991 Priestman et al. 1993 Spitzer et al. 1994 Prentice et al. 1995 Bey et al. 1996 Franzén et al. 1996 Aass et al. 1997 Khoo et al. 1997 Sykes et al. 1997 Kirkbride et al. 2000 Spitzer et al. 2000 Lanciano et al. 2001 Martin et al. 2002 Wong et al. 2006 |
systematic review and meta-analysis of randomized controlled trials
17 RCTs
literature search Ovid MEDLINE: 1946 -09/2015 EMBASE: 1947 -09/2015 Cochrane CENTRAL: until 09/2015
China, Canada |
patients receiving radiotherapy to abdomen/pelvis, including total body irradiation (TBI). |
5HT3 RA
5HT3 RA and dexamethasone
dexamethasone
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placebo
dopamine receptor antagonist
rescue therapy
chlorpromazine plus dexamethasone
5HT3 RA plus placebo
placebo
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Primary endpoints: complete control of nausea and complete control of vomiting during acute and delayed phases
Secondary endpoints: use of rescue medication, quality of life (QoL) and incidence of adverse events |
5HT3 RA versus placebo complete control of vomiting: OR 0.49; 95% CI: 0.33–0.72 complete control of nausea: OR 0.43; 95% CI: 0.26–0.70
5HT3RA versus dopamine receptor antagonist Complete control of vomiting: OR 0.17; 95% CI: 0.05–0.58 complete control of nausea: OR 0.46; 95% CI: 0.24–0.88
5HT3 RA plus dexamethasone versus 5HT3 RA plus placebo
Wong et al
fractions 1–5: complete control of nausea: 50% vs. 38%, P=0.06 control of vomiting: 78% vs. 71%, P=0.14
fractions 1–15: complete control of vomiting: 23% vs. 12%, P=0.02 |
requiring rescue medication Aass et al. tropisetron vs. metoclopramide: 18.2% vs. 25%, P value NR Wong et al. Ondansetron + dexamethasone:70% vs. 80%, P=0.09 Kirkbride et al. dexamethasone vs. placebo group: 29% vs. 43%, P=0.125 Spitzer et al. TBI - ondansetron vs. placebo: 40% vs. 0%, P value NR Prentice et al. TBI - granisetron group vs. combination therapy of metoclopramide, dexamethasone and lorazepam: 46.7% vs. 93.3%, P=0.05 QoL Franzén et al. EORTC QLQ-C30 ondansetron vs. placebo: better functioning, global QoL and lower symptom levels at week 2 Wong et al. (30) EORTC QLQ-C30 ondansetron + dexamethasone: significant benefits in appetite, nausea and vomiting and a trend favouring global QoL improvement; marginally worse outcomes in sleep and constipation scales. Sykes et al. (26) Functional Living Index Cancer (FLIC) and Functional Living Index Emesis (ELIE) no difference for the FLIC questionnaire, FLIE: difference in favour of the ondansetron vs. chlorpromazine plus dexamethasone Kirkbride et al. (27) EORTC QLQ-C30 no difference in global QoL dexamethasone vs. placebo: better scores in the domains of nausea/vomiting and appetite but a lower score in the domain of sleep |
Bratty Family Fund, Michael and Karyn Goldstein Cancer Research Fund, Joey and Mary Furfari Cancer Research Fund, Pulenzas Cancer Research Fund, Joseph and Silvana Melara Cancer Research Fund, and Ofelia Cancer Research Fund. |
1 only puplished papers were included
"5HT3 RAs are more effective than other antiemetics for prophylaxis of RINV in patients receiving radiotherapy to abdomen/pelvis and TBI. Future RCTs should investigate the efficacy of newer agents such as substance P neurokinin 1 receptor antagonists in addition to 5HT3 RAs in prophylaxis of RINV during both acute and delayed phases." |