Chemotherapy-Induced Nausea Prevention With Olanzapine

• Cancer chemotherapy causes nausea and vomiting, thereby making the treatment unpleasant
• Medications including dexamethasone, neurokinin-1 (NK-1) receptor antagonists such as aprepitant or fosaprepitant, and a 5-hydroxytryptamine type 3–receptor antagonist like ondansetron or granisetron have been used to prevent vomiting in patients undergoing chemotherapy.
• Addition of olanzapine to the above drugs could control nausea as well

The anti-psychotic drug olanzapine may be useful in the prevention of chemotherapy-induced nausea and vomiting, according to a study published in the New England Journal of Medicine. Chemotherapeutic drugs used in the treatment of cancer are associated with side effects like nausea and vomiting. These could make the experience unpleasant for the patient. Several anti-emetic drugs have been used to treat nausea and vomiting associated with cancer treatment, but the response is often inadequate.

A recently published study evaluated the use of olanzapine in the treatment of chemotherapy-induced nausea and vomiting. Olanzapine is an atypical antipsychotic drug with antiemetic properties. It is mainly used in the treatment of psychotic conditions like schizophrenia and mania. Though its exact mechanism of action is not known, it probably acts by blocking dopamine and serotonin receptors, thereby reducing the effects of these chemicals. These chemicals have been implicated in causing chemotherapy-induced nausea and vomiting.

The researchers studied the use of olanzapine in patients receiving Cisplatin or cyclophosphamide – doxorubicin, which are anticancer drugs associated with severe nausea and vomiting. The patients received the chemotherapy for the first time. Most patients were being treated for breast cancer. Three drugs were given before and after the chemotherapy to reduce vomiting - dexamethasone which is a steroid, neurokinin-1 (NK-1) receptor antagonists such as aprepitant or fosaprepitant, and a 5-hydroxytryptamine type 3–receptor antagonist like ondansetron or granisetron. The patients were divided into two groups through a process called randomization. One group also received 10 mg of olanzapine orally on days 1 through 4. The other group received a matching placebo. The patients were monitored for a period of 5 days. The final analysis was done on 192 patients in the olanzapine group and 188 patients in the placebo group

The researchers found that the proportion of patients who did not suffer from nausea due to the chemotherapy was higher in the olanzapine group as compared to the placebo group. This advantage was recorded on day 1 after chemotherapy (74% in the olanzapine group vs. 45% in the placebo group), the period from the second to the fifth day (42% in the olanzapine group vs. 25% in the placebo group), and the overall 5 day period of the study (37% in the olanzapine group vs. 22% in the placebo group). The complete-response rate wherein the patient did not experience any vomiting or needed additional medications for the same was also higher in patients receiving olanzapine. Side effects of olanzapine included increased sedation on day 2 of treatment.

Therefore, olanzapine has a potential to prevent nausea in the early as well as late period following chemotherapy. Further studies probably with a range of doses may be useful in establishing the use of olanzapine for this indication.

Reference:

1. Navari RM, Qin R, Ruddy KJ, Liu H, Powell SF, Bajaj M, Dietrich L, Biggs D, Lafky JM, Loprinzi CL. Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting. N Engl J Med 2016; 375:134-142 DOI: 10.1056/NEJMoa1515725

Source-Medindia