Olanzapine for Preventing Nausea and Vomiting Induced by Moderately and Highly Emetogenic Chemotherapy

Abstract

Nausea and vomiting are common adverse events in chemotherapy. In spite of the serious effects on the quality of life and further treatment, they remain overlooked by physicians, and no standard treatment has been developed. Neurokinin-1 (NK-1) receptor antagonists and palonosetron are the major agents in the standard regimen for treating moderately and highly emetogenic chemotherapy-induced nausea and vomiting (CINV). However, NK-1 receptor antagonists first became commercially available at the end of 2013 and palonosetron has not been extensively applied in China. Olanzapine was recommended as a therapy for moderate and severe CINV in antiemesis-clinical practice guidelines in oncology in 2014 for the first time. It is an atypical antipsychotic agent, which can block multiple receptors on neurotransmitters. During more than 10 years, olanzapine has demonstrated significant effects in preventing CINV and treating breakthrough and refractor CINV, which was observed in case reports, precise retrospective studies, and phase Ⅰ, Ⅱ and Ⅲ clinical trials, with no grade 3 to 4 adverse events. In particular, it is superior to aprepitant and dexamethasone in delayed nausea and vomiting. Therefore, this compound is worthy of further investigation.

New therapies for antiemetic prophylaxis for chemotherapy

“…59 Several smaller trials have added olanzapine to standard chemotherapy antiemetic prophylaxis. 11,[60][61][62][63][64][65][66][67][68][69][70][71][72][73] Doses in these studies ranged between 5-10 mg daily for 5 days. Te combination of olanzapine, palonosetron, and dexamethasone has been compared with standard palonosetron, APR, and dexamethasone for patients receiving MEC and HEC in an open label study.…”

Relationship between traditional Chinese medicine constitutional types with chemotherapy-induced nausea and vomiting in patients with breast cancer: an observational study

“…Since female gender itself is an independent risk factor for CINV [3], CINV in women with breast cancer might be even more common and severe compared with other cancers. Indeed, 77.3 % of patients with breast cancer experience nausea and 50 % experience vomiting [4], severely affecting the quality of life and requiring anti-emetic treatments [5]. …”