Olanzapine Combined With Standard Antiemetic Regimens for Prevention of Chemotherapy Therapy-Induced Nausea and Vomiting: A Single-Center Experience From South India

Abstract

Objectives: Olanzapine, an antipsychotic agent, exhibits significant antiemetic properties due to its inhibitory activity on neurotransmitters at multiple receptors involved in chemotherapy-induced nausea and vomiting (CINV). CINV can have an immensely negative impact on patient's quality of life (QOL) and daily activities. Our objectives were to determine the effectiveness of adding olanzapine to standard antiemetic regimens for the prevention of CINV in cancer patients and to compare the QOL of such patients with those receiving standard antiemetic regimens. Methods:A prospective, observational, cohort study was done on patients receiving either highly or moderately emetogenic chemotherapy (MEC). The patients who received only the standard antiemetic regimens were considered as the control group and those who received 10 mg of olanzapine once daily on days 1-5 of chemotherapy in addition to the standard antiemetic regimens were considered to be the study group. The patients were assessed for grades of nausea and vomiting using National Cancer Institute common terminology criteria for adverse events and for QOL using European Organization in Research and Treatment of Cancer QOL questionnaire. Results:Patients were evaluated for a total of 168 cycles of chemotherapy. Compared to the control group, the study group patients showed significant improvement in response to acute nausea (p=0.02) but not in acute vomiting (p=0.09). However, response to delayed nausea and vomiting improved significantly (p=0.004 and p=0.05, respectively). The QOL of study group patients showed significant improvement in functional scales and symptom scales (p<0.02). Global health status also increased significantly (p=0.02) in the study group patients. Conclusion:Olanzapine containing pre-medication regimens can reduce acute and delayed nausea and delayed vomiting and improve the QOL of cancer patients receiving highly or moderately emetogenic chemotherapeutic agents as compared to the standard pre-medication regimens.

Efficacy of olanzapine for quality of life improvement among patients with malignant tumor: A systematic review

“…Improvement of emotional functioning was reported among patients of olanzapine groups in all three studies that used the EORTC QLQ‐C30 as a HRQoL measure instrument ( P < 0.05) . In two of these three studies, the change of cognitive functioning in olanzapine groups was observed, but there was no statistical significance ( P > 0.05) . In one study, which adopted the WHOQOL‐BREF, mental health of patients was not improved significantly at the end of olanzapine treatment ( P > 0.05)…”

“…Five of six studies reported results of general HRQoL change. In two of three studies which used the EORTC QLQ‐C30, HRQoL was significantly improved among patients who received olanzapine both in short term (6 days, P < 0.01) and in long term (after four cycles of chemotherapy, P = 0.01) compared with the non‐olanzapine group. The remaining one indicated that the general HRQoL status of patients in the olanzapine group was stable between the 8 th and 10 th day after chemotherapy, whereas it was worse in the control group .…”

“…There were 13 full‐paper studies being further reviewed, among which seven were excluded owing to noncomparative study design, having not included HRQoL as an endpoint, or being a duplicate publication. In the end, six articles were included in this review, two of which are randomized controlled trials (RCT), three had quasi‐experimental designs, and one is cohort study (Table ).…”

“…There were four instruments assessing HRQoL being identified. The European Organisation of Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ) Core 30 (EORTC QLQ‐C30) was adopted in three studies (50%) . The remaining three studies used the Functional Assessment of Cancer Therapy‐General (version 3) (FACT‐G), the World Health Organization Quality of Life (WHOQOL‐BREF) questionnaires, and the Functional Living Index‐Emesis (FLI‐E) questionnaire, respectively (Table ).…”

“…However, patients who received the same treatment (10‐mg olanzapine p.o. Qd, D1‐5) have experienced a better physical functioning after four cycles of chemotherapy . In one study which used the WHOQOL‐BREF, improvement of physical functioning was also observed after an 8‐week treatment of olanzapine…”