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

Abstract

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.

The Role of Nutritional Support for Cancer Patients in Palliative Care

“…The American Society of Clinical Oncology (ASCO) suggested the palliative care integrated early into oncology care is helpful for patients and families and complements the anticancer treatments [ 14 , 15 , 16 , 17 ]. The European Society of Medical Oncology (ESMO) proposed the term “patient-centered care” to defined care that aims to optimize the comfort, function, and social support of the patients and their families at all stages of the illness.…”

The Balance Between the Effectiveness and Safety for Chemotherapy-Induced Nausea and Vomiting of Different Doses of Olanzapine (10 mg Versus 5 mg): A Systematic Review and Meta-Analysis

“…Eleven studies ( 28 – 34 , 36 – 39 ) are randomized controlled experiments; one study ( 35 )is a prospective control study; and nine studies ( 28 – 31 , 33 , 34 , 37 – 39 ) compared 5 or 10 mg olanzapine with placebo, while three studies ( 32 , 35 , 36 ) compared the four-drug regimen with standard regimen; and 12 studies differed in the drugs used in the concurrent antiemetic regimens: a corticosteroid, 5-HT3 receptor antagonist, and NK1 receptor antagonist in seven studies ( 28 – 32 , 36 , 39 ) and a corticosteroid and 5-HT3 receptor antagonist in five studies ( 33 – 35 , 37 , 38 ).…”

“…Nine studies ( 31 – 39 ) reported the use of 10 mg olanzapine to prevent CINV; three studies ( 28 – 30 , 40 , 41 )reported the use of 5 mg olanzapine to prevent CINV; five studies ( 31 , 32 , 37 – 41 ) included HEC patients; two studies ( 29 , 33 )included MEC patients; and five studies ( 28 , 30 , 34 – 36 )included HEC and MEC patients. Of the five studies involving both HEC and MEC, only three studies ( 34 – 36 ) reported the results of HEC and MEC separately, and two studies were not enough for subgroup analysis; eight studies ( 28 , 29 , 31 – 35 , 37 ) reported adverse reactions including sedation, Table 2 provides the procedures of each study to evaluate the sedative effect of olanzapine; 11 studies ( 28 – 34 , 36 – 39 ) are randomized controlled experiments; 1 study ( 35 ) is a prospective control study ( 40 , 41 ); 9 studies used a double-blind placebo-controlled approach; and 3 studies ( 32 , 35 , 36 ) were unclear on blind methods.…”

“…All studies are CINV for adults. Nine studies (31-39) reported the use of 10 mg olanzapine to prevent CINV; three studies (28-30, 40, 41) (40,41); 9 studies used a double-blind placebo-controlled approach; and 3 studies (32,35,36) were unclear on blind methods.…”

Olanzapine for the prophylaxis and rescue of chemotherapy-induced nausea and vomiting: a systematic review, meta-analysis, cumulative meta-analysis and fragility assessment of the literature

“…After removing duplicate records and adding records identified from included trials, 178 records underwent level 1 screening. A total of 34 full-text articles were assessed for eligibility through level 2 screening, at which points 6 were excluded with reason-three were not a randomized controlled trial [36][37][38], one did not investigate olanzapine in the CINV setting [39], and two did not have an appropriate treatment regimen for inclusion in our review [40,41]. Of the remaining 28 articles, 25 randomized controlled trials had extractable data and were included in this systematic review and metaanalysis(Appendix 4 Electronic Supplementary Material).…”