Cheaper Options in the Prevention of Chemotherapy-Induced Nausea and Vomiting

PurposeChemotherapy-induced nausea and vomiting (CINV) is a distressing adverse effect. Neurokinin-1 receptor antagonist (NK1RA)–containing regimens are the standard regimens for CINV prophylaxis in patients with cancer receiving highly or moderately emetogenic chemotherapy (HEC or MEC). NK1RA agents are expensive and were not registered in Sudan. Recently, regimens containing olanzapine, the available and affordable medication in Sudan, were introduced as another option. This study aimed to compare the efficacy of an olanzapine-containing regimen with the antiemetic regimen that was currently used in our institute for CINV prophylaxis in HEC/MEC settings.Patients and MethodsThe study prospectively compared an olanzapine-containing regimen (acute phase: olanzapine, ondansetron, dexamethasone; delayed phase: olanzapine, ondansetron) with an ondansetron/dexamethasone regimen (acute phase: ondansetron, dexamethasone; delayed phase: ondansetron) in adult patients with cancer receiving HEC or MEC. The study outcomes were complete response (CR; no emesis and no rescue medications) and nausea control (no nausea), which were assessed in the acute (0 to 24 hours), delayed (24 to 120 hours), and overall (0 to 120 hours) phases.ResultsThe study included 131 patients (olanzapine-containing: 50 patients; ondansetron/dexamethasone: 81 patients). CR and nausea control were higher in the olanzapine-containing than in the ondansetron/dexamethasone regimen (CR: acute phase, 86% v 71.6%; P = .086; delayed phase, 72% v 30.9%; P < .001; overall phase, 66% v 25.9%; P < .001; nausea control: acute phase, 86% v 74.1%; P = .127; delayed phase, 76% v 34.6%; P < .001; overall phase, 72% v 29.6%; P < .001). The major toxicity of olanzapine was grade 1 and 2 sedation or drowsiness (25 patients).ConclusionAn olanzapine-containing regimen has better efficacy for prevention of CINV in the HEC/MEC setting. Oncologists working in a limited-resource setting should be familiar with olanzapine-containing regimens, because NK1RA agents are not affordable and not easily available.

show abstract

“… 15 Agents of these regimens, such as aprepitant and palonosetron, are expensive, and patients in developing countries cannot afford them. 16 …”

Section: Discussionmentioning

confidence: 99%

“… 10 , 12 - 14 Although NK1RA-containing regimens significantly improve the control of acute and delayed emesis in patients receiving HEC and MEC, 15 these regimens are underused in resource-limited settings because of the unavailability and high cost of NK1RA agents. 16 …”

Section: Introductionmentioning

confidence: 99%

Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting: A Comparative Study From Sudan

Osman

Elhassan

AbdElrahim

et al. 2018

JGO

View full text Add to dashboard Cite

show abstract

“…LMIC can particularly focus on drug repurposing and other more affordable alternatives, for example supporting an intrinsic generics industry such as India has done. For instance, olanzapine provides good prophylaxis against chemotherapy induced nausea and vomiting but costs very little when compared to the alternative of aprepitant (Gyawali et al 2016). Such trials exploring cheaper agents are unlikely to be funded by the private sector and hence the governments should play an active role in encouraging these approaches.…”

Section: What Needs To Change?mentioning

confidence: 99%

Economics of Cancer Medicines: For Whose Benefit?

Gyawali

Sullivan

2017

The New Bioethics

Self Cite

View full text Add to dashboard Cite

Although new cancer drugs are continually getting approved and used, the value that these drugs add is very debatable. Because of the skyrocketing cost of the new drugs, each new approval represents a multibillion market. However, unlike other branches of economics, cancer drugs are intricately associated with socio-political issues, emotional overlay, public pressure, industry manipulation and propaganda. In this article, we review the value added by new cancer drugs and examine the socio-political agenda around them with highlights on the increasing gulf between high-income and low-middle income countries regarding the affordability to these drugs. Finally, we also suggest a way forward to address this highly complex issue.

show abstract

“…However, drugs used for supportive care of cancer patients such as antiemetics for chemotherapy induced nausea and vomiting also add significantly to the overall cost, not only because they are expensive but also because they are used with every cycle of treatment. For example, using an olanzapine–palonosetron–dexamethasone regimen instead of the standard aprepitant–palonosteron–dexamethasone regimen provides similar protection against chemotherapy induced nausea and vomiting but costs nearly $500 less per cycle [39]. Similar other cheaper, evidence based alternatives should be sought, studied and implemented [39].…”

mentioning

confidence: 99%

“…For example, using an olanzapine–palonosetron–dexamethasone regimen instead of the standard aprepitant–palonosteron–dexamethasone regimen provides similar protection against chemotherapy induced nausea and vomiting but costs nearly $500 less per cycle [39]. Similar other cheaper, evidence based alternatives should be sought, studied and implemented [39]. …”

mentioning

confidence: 99%

Low-value practices in oncology contributing to financial toxicity

Gyawali¹

2017

ecancer

Self Cite

View full text Add to dashboard Cite

Financial toxicity of cancer treatment is now a well-recognised problem in cancer medicine leading to patient bankruptcy and even poor survival, including in high-income countries and countries with public health care systems. Many oncologists, despite acknowledging the severity of financial toxicity as a problem, resign the responsibility of reducing the costs of cancer treatment to the government, industry, and oncology societies. However, an oncologist can play an important role in reducing the costs of cancer treatment because all cancer treatment decisions are made between the oncologist and the patient. In this article, I point out a few examples of low value practices from various oncology disciplines that we oncologists can easily replace or abandon in our practice and contribute to lessening the financial toxicities to patients and society. As these examples suggest, reducing cost does not necessarily mean compromising efficacy. We should continuously keep looking for other similar cost-saving strategies in our practice.

show abstract

Cheaper Options in the Prevention of Chemotherapy-Induced Nausea and Vomiting

Cited by 18 publications

References 56 publications

Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting: A Comparative Study From Sudan

Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting: A Comparative Study From Sudan

Economics of Cancer Medicines: For Whose Benefit?

Low-value practices in oncology contributing to financial toxicity

Contact Info

Product

Resources

About