Olanzapine Eases Chemo-Induced Nausea and Vomiting

TOPLINE:

Olanzapine improves chemotherapy-induced nausea and vomiting and leads to higher complete response rates, reduced need for rescue medications, and improved quality of life in patients with solid malignant tumors at moderate risk for chemotherapy-induced nausea and vomiting, a new analysis finds.

METHODOLOGY:

• Chemotherapy-induced nausea and vomiting can impact quality of life in patients with cancer. Olanzapine — an atypical antipsychotic agent — has been approved as part of antiemetic prophylaxis in patients receiving chemotherapy regimens that come with a high risk for nausea and vomiting; the agent may also help those at more moderate risk for chemotherapy-induced nausea and vomiting.
• Researchers evaluated whether receiving antiemetic prophylaxis with olanzapine reduced nausea and vomiting and improved complete response rates in patients at more moderate risk for chemotherapy-induced nausea and vomiting.
• In the phase 3 randomized study, 544 patients (median age, 51 years) with solid malignant tumors received either oxaliplatin-, irinotecan-, or carboplatin-based chemotherapy regimens at three institutes in India and were randomly assigned to antiemetic prophylaxis that included dexamethasone, aprepitant, and palonosetron with or without 10 mg olanzapine.
• The primary endpoint was the rate of complete response — defined as no vomiting, a nausea score < 5 on the visual analog scale, and no use of rescue medications during the first 120 hours of chemotherapy. Secondary endpoints included the proportion of patients who experienced nausea or chemotherapy-induced nausea and vomiting and who received rescue medications.

TAKEAWAY:

• Overall, patients who received olanzapine had a significantly higher complete response rate (91%) than those not receiving olanzapine (82%). This effect was significant after 25 hours (92% vs 83%; P = .001) but not within the first 24 hours of the chemotherapy cycle (96% vs 94%; P = .53).
• The addition of olanzapine improved complete response rates in patients who received oxaliplatin-based chemotherapy (odds ratio [OR], 0.36) and carboplatin-based chemotherapy (OR, 0.23) but not irinotecan-based chemotherapy (OR, 2.36; 95% CI, 0.23-24.25).
• Olanzapine led to better nausea control, with 96% of patients achieving a nausea score < 5 on the visual analog scale compared with 87% in the observation group (P < .001) as well as eased chemotherapy-induced nausea and vomiting (96% vs 91%; P = .02). Olanzapine also reduced the need for rescue medications — only 4% of patients in the olanzapine group received rescue medications vs 11% of patients not receiving olanzapine — and improved patients’ quality of life.
• However, 10% of the patients in the olanzapine group experienced grade 1 somnolence, whereas none in the observation group reported this side effect.

IN PRACTICE:

“Olanzapine 10 mg, combined with aprepitant, palonosetron, and dexamethasone, improved complete response rates compared with no olanzapine,” the authors concluded. “These findings suggest that this regimen could be considered as one of the standards of antiemetic therapy” in patients receiving chemotherapy regimens associated with a moderate risk for chemotherapy-induced nausea and vomiting.