Researchers have found that olanzapine may be more effective in controlling severe nausea and improving the quality of life in patients with cancer who are undergoing treatment with chemotherapy, according to new findings presented by Peppone et al at the 2024 ASCO Quality Care Symposium (Abstract 185).
Background
“Chemotherapy-induced nausea is a highly prevalent and distressing side effect of chemotherapy, which significantly impairs patients’ quality of life,” explained Oreofe O. Odejide, MD, MPH, a medical oncologist at Dana-Farber Cancer Institute.
Study Methods and Results
In the new study, the researchers administered the standard ASCO-recommended antinausea treatment during the first cycle of chemotherapy in 1,363 patients with cancer. They then counted how many patients experienced at least moderate nausea—defined as a nausea score of 3 or higher on a scale of 1 to 7, with 7 being extreme nausea.
Among the patients involved in the study, 310 of them experienced at least moderate nausea during their first cycle of chemotherapy and agreed to continue with the study. These patients were then randomly assigned to receive either olanzapine, prochlorperazine, or placebo in combination with the standard antinausea treatment during their next cycle of chemotherapy. Following treatment, the patients used an at-home diary to record their nausea levels four times per day for 4 days as well as the number of vomiting episodes, nausea drugs received, and whether they visited the emergency department.
The researchers found that both olanzapine and prochlorperazine significantly reduced nausea during chemotherapy compared with the placebo. In both the olanzapine and prochlorperazine groups, the average nausea score decreased by about 1 point on the nausea scale following treatment. For severe nausea, olanzapine was more effective compared with prochlorperazine. The patients who received olanzapine saw a 2.5-point decrease in their maximum nausea score compared with a 2-point decrease among those who received prochlorperazine. Additionally, the patients who received olanzapine saw a significant improvement in their overall quality of life compared with those in the placebo group, whereas the patients who received prochlorperazine did not.
Conclusions
“These important findings highlight the potential for olanzapine to provide more effective relief for patients who suffer from severe nausea despite standard antiemetic treatments. This is valuable evidence for health-care providers to help guide treatment strategies,” emphasized lead study author Luke Peppone, PhD, of the University of Rochester Medical Center. “For patients, this means there may be a more effective option available to improve their symptoms and overall well-being during chemotherapy. This could ultimately make the chemotherapy experience more tolerable and manageable, contributing to better overall outcomes and patient satisfaction,” he underscored.
The researchers plan to explore how olanzapine and prochlorperazine may affect nausea based on the type of chemotherapy and by the known potential of the chemotherapy to cause nausea. They are also examining biological samples from patients to identify biomarkers that could predict nausea levels and identify which patients may be most likely to develop significant nausea.
“The findings of this study position olanzapine as a promising intervention for patients with refractory chemotherapy-induced nausea,” concluded Dr. Odejide.
Disclosure: The research in this study was funded by the National Cancer Institute. For full disclosures of the study authors, visit meetings.asco.org.
