Olanzapine Combination Reduces Nausea and Vomiting in Patients Receiving Highly Emetogenic Chemotherapy

Key Points

  • Among patients receiving highly emetogenic chemotherapy, olanzapine significantly reduced nausea during the acute and delayed periods and overall.
  • Olanzapine significantly increased complete response rates during the acute and delayed periods and overall.

In a phase III trial reported by Navari et al in The New England Journal of Medicine, the addition of the antipsychotic agent olanzapine vs placebo to dexamethasone, aprepitant, or fosaprepitant, and a 5-hydroxytryptamine type 3–receptor antagonist reduced nausea and improved antiemetic complete response rates among patients receiving highly emetogenic chemotherapy.

Study Details

In the double-blind trial, 380 evaluable patients were randomized to receive olanzapine at 10 mg or placebo daily on days 1 to 4 of chemotherapy cycles. These patients had had no previous chemotherapy and were receiving cisplatin at ≥ 70 mg/m2 or cyclophosphamide/doxorubicin. The primary endpoint was prevention of nausea. Complete response, defined as no emesis and no use of rescue medication, was a secondary endpoint.

Nausea Prevention and Complete Response

No chemotherapy-induced nausea within the first 24 hours after chemotherapy was achieved in 74% of patients in the olanzapine group vs 45% of patients in the placebo group (P = .002). Higher proportions of olanzapine patients were also free of nausea at 25 to 120 hours (42% vs 25%, P = .002) and across the overall 120-hour period (37% vs 22%, P = .002). Complete response was significantly more common with olanzapine for all three periods: 86% vs 65% (P < .001), 67% vs 52% (P = .007), and 64% vs 41% (P < .001), respectively. Severe sedation was observed in 5% of olanzapine patients on day 2 of treatment.

The investigators concluded: “Olanzapine, as compared with placebo, significantly improved nausea prevention, as well as the complete-response rate, among previously untreated patients who were receiving highly emetogenic chemotherapy.”

The study was funded by the National Cancer Institute.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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