Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting
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Reviewed & Translated by Dat Tien Nguyen, B.A, ScM.
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Posted on September 23rd, 2024
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Nausea and vomiting are common side effects of chemotherapy, particularly with regimens involving oxaliplatin, irinotecan, and carboplatin, making antiemetic prophylaxis crucial for enhancing patients' quality of life. Olanzapine, an antipsychotic often used to treat schizophrenia, was recently evaluated in a study published in the Journal of the American Medical Association to determine whether its antiemetic properties could aid in the prevention of these side effects in patients undergoing chemotherapy.
The phase 3 clinical trial involved 560 patients receiving treatment for solid malignant tumors. Colorectal cancer was reported by 58% of participants, while gastroesophageal cancer, non–small cell lung carcinoma, biliary tract carcinoma, and bladder cancer were each seen at approximately 10% for each. Over half of the patients had stage IV tumors, and about 45% had stage III disease. The patients were undergoing moderately emetogenic chemotherapy, with more than 60% receiving oxaliplatin-based regimens, 30% on carboplatin, and 10% on irinotecan. Participants were randomly assigned to receive either a placebo or 10 mg of olanzapine orally on the first and third days of chemotherapy. All patients were also treated with dexamethasone and the standard antiemetic regimen of palonosetron and aprepitant. Within the first 120 hours post-chemotherapy, olanzapine prevented vomiting and significantly reduced nausea in 91% of participants, compared to 82% in the group receiving standard antiemetic agents alone. The researchers noted that olanzapine increased the risk of somnolence, along with a higher incidence of increased appetite and constipation. A key limitation of the study was the overrepresentation of patients with gastrointestinal cancers, indicating a need for future research in other cancer types.
The phase 3 clinical trial involved 560 patients receiving treatment for solid malignant tumors. Colorectal cancer was reported by 58% of participants, while gastroesophageal cancer, non–small cell lung carcinoma, biliary tract carcinoma, and bladder cancer were each seen at approximately 10% for each. Over half of the patients had stage IV tumors, and about 45% had stage III disease. The patients were undergoing moderately emetogenic chemotherapy, with more than 60% receiving oxaliplatin-based regimens, 30% on carboplatin, and 10% on irinotecan. Participants were randomly assigned to receive either a placebo or 10 mg of olanzapine orally on the first and third days of chemotherapy. All patients were also treated with dexamethasone and the standard antiemetic regimen of palonosetron and aprepitant. Within the first 120 hours post-chemotherapy, olanzapine prevented vomiting and significantly reduced nausea in 91% of participants, compared to 82% in the group receiving standard antiemetic agents alone. The researchers noted that olanzapine increased the risk of somnolence, along with a higher incidence of increased appetite and constipation. A key limitation of the study was the overrepresentation of patients with gastrointestinal cancers, indicating a need for future research in other cancer types.