Low-Dose Olanzapine Effectively Reduces chemotherapy induced vomiting in Cancer Patients

A recent study discovered that a lower dose of Olanzapine (OLZ) is just as effective as the standard dose for chemotherapy-induced nausea and vomiting (CINV), while it also significantly reduced daytime somnolence in cancer patients, The outcomes were presented in San Antonio Breast Cancer Symposium 2023.

CINV poses a significant burden on cancer patients undergoing highly emetogenic chemotherapy (HEC). The standard 10 mg dose of Olanzapine, when combined with triple antiemetics (TAE), has demonstrated it's efficacy. However, the accompanying daytime somnolence has limited its widespread use. This prompted researchers to explore the potential of a lower dose of OLZ in conjunction with a single dose of steroids.

The randomized study included patients with solid tumors slated for anthracycline-cyclophosphamide and high-dose cisplatin chemotherapy. Patients were divided into two groups as one receiving the standard 10mg OLZ (standard arm) and the other receiving a reduced 2.5mg dose (experimental arm) with TAE. Evaluating the Complete Control Rate (CCR), including the absence of emetic episodes, no use of rescue medications, and no or mild nausea were the primary objective.

The study comprised a total of 267 analyzable subjects who demonstrated that the 2.5mg dose was non-inferior to the 10mg dose in controlling CINV without the need for delayed steroids. The CCR in the overall phase was comparable between the two groups (44.7% vs. 43.7%). Also, the lower dose significantly reduced daytime somnolence, with 65.2% in the 2.5mg group compared to 89.6% in the 10mg group (p < 0.001).

The outcomes of this study conclude that a low dose of 2.5mg Olanzapine is effective as the standard 10mg dose in controlling CINV during highly emetogenic chemotherapy. Also, the reduced dosage regimen shows superiority in reducing daytime somnolence and offers an effective alternative for cancer patients. 

Source:

Bajpai J, Kapu V, Rath S, et al. A randomized, open-label phase III trial evaluating low- dose vs standard-dose olanzapine with triple antiemetic therapy for prevention of highly emetogenic chemotherapy- induced nausea and vomiting in solid tumors (OLAnzaPiNE). Presented at SABCS 2023. December 5-9, 2023. San Antonio, TX. Abstract RF01-08