Olanzapine may prevent vomiting among patients with moderately emetogenic chemotherapy: JAMA

A new study published in the Journal of American Medical Association suggests that in patients receiving mildly emetogenic chemotherapy, olanzapine added to the usual dose of dexamethasone, palonosetron, and aprepitant greatly improved the management of nausea and vomiting. In regimens of moderately emetogenic chemotherapy (MEC), either with or without neurokinin-1 receptor antagonists, the function of olanzapine has not been well assessed. Thereby, this study by Vikas Ostwal and colleagues wanted to determine if adding olanzapine to a maintenance of consciousness regimen lowers nausea, vomiting, and the need for nausea rescue drugs in patients with hard malignant tumors.

The patients undergoing treatment with oxaliplatin, carboplatin, or irinotecan-based solid malignant tumors who were 18 years of age or older were enrolled in this randomized clinical research. From March 26, 2019 to August 26, 2023, 3 institutes in India performed the experiment and the patients were randomized 1:1 to receive either olanzapine-free (observation group) or olanzapine-containing (experimental group) dexamethasone, aprepitant, and palonosetron. On days 1 through 3 of the chemotherapeutic treatment, the experimental group was given 10 mg of olanzapine orally once at night. Complete response (CR) is the percentage of patients who did not vomit, did not have severe nausea, and did not require rescue medicine for nausea, was the primary outcome measured. 

A total of 560 individuals in all were randomized. There were 544 patients having evaluable data in the analysis where the two baseline characteristics of the groups matched exactly. Throughout the course of the 120-hour treatment period, the percentage of patients with CR was substantially higher in the group taking olanzapine (248 [91%]) than in the group not taking it (222 [82%]).

The proportion of patients receiving rescue medications increased significantly in the observation group (30 [11%]) when compared with the olanzapine group (11 [4%]), and there were also significant differences for nausea control between the observation and olanzapine groups during the entire assessment period. Grade 1 somnolence was recorded by 27 patients (10%) after receiving chemotherapy plus olanzapine, but no individuals in the observation group. Overall, the findings of this study imply that one of the standards of treatment in these chemotherapy regimens should be the use of olanzapine.

Source:

Ostwal, V., Ramaswamy, A., Mandavkar, S., Bhargava, P., Naughane, D., Sunn, S. F., Srinivas, S., Kapoor, A., Mishra, B. K., Gupta, A., Sansar, B., Pal, V., Pandey, A., Bonda, A., Siripurapu, I., Muddu, V. K., Kannan, S., Chaugule, D., Patil, R., … Olver, I. (2024). Olanzapine as Antiemetic Prophylaxis in Moderately Emetogenic Chemotherapy. In JAMA Network Open (Vol. 7, Issue 8, p. e2426076). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.26076