Olanzapine for the prevention and treatment of cancer-related nausea and vomiting in adults

Sutherland, Anna; Naessens, Katrien; Plugge, Emma; Ware, Lynda; Head, Karen; Burton, Martin J; Wee, Bee

doi:10.1002/14651858.cd012555.pub2

Cited by 42 publications

(41 citation statements)

References 61 publications

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“… FBC - full blood count; BM blood glucose measurement *Level of evidence supporting its use via the oral route as an anti-emetic in chemotherapy induced nausea and vomiting (CBEM): 1a (multiple meta-analyses) number needed to treat to benefit: 5; number needed to treat to harm: 19 22 …”

Section: Resultsmentioning

confidence: 99%

Orodispersible and transmucosal alternative medications for symptom control in adults

Sutherland

Presland

Harrop³

et al. 2020

BMJ Support Palliat Care

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BackgroundPaediatric palliative care makes frequent use of orodispersible and transmucosal drug delivery routes. The limited published experience of this practice suggests that it enables the delivery of needle-free symptom relief, with the potential to train family carers to administer anticipatory medications without reliance on trained health professionals.AimsTo identify orodispersible and potential transmucosal alternatives that may be used in adults in the event of a patient having no oral or intravenous route and no access to subcutaneous injections.MethodsThe author panel identified medications through review of multiple drug formularies, review of the published evidence and their experience. Where possible, licensed alternatives were identified and any ‘off label’ or unlicensed medications clearly highlighted.ResultsA list of 27 medications is provided, which could be used either via the orodispersible or transmucosal alternative route for healthcare professionals delivering end of life care to consider when the licensed alternative routes are unavailable. All users of this guide are encouraged to use their professional judgement whenever selecting a medication for a patient, recognising that this review is neither a guideline nor a systematic review, and taking account of licensing considerations, adverse effects, potential unpredictability of time to effect and contraindications.ConclusionShould it be necessary to use these orodispersible or transmucosal alternatives then any experience gained should be reported in the literature. Combined with further research, this experience offers the possibility of reducing injection frequency and inherent delays in medication administration, particularly in the community setting during the COVID-19 pandemic.

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Section: Resultsmentioning

confidence: 99%

Orodispersible and transmucosal alternative medications for symptom control in adults

Sutherland

Presland

Harrop³

et al. 2020

BMJ Support Palliat Care

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“…This review is the most rigorous systematic review to date investigating olanzapine in the CINV setting. A protocol was developed prior to the commencement, risk of bias for studies were assessed, and publication bias was assessed; some or all of these three methodological elements were omitted in prior reviews [21][22][23][24][25][26][27]. This review also has the highest statistical power and appraises all the clinically important endpoints.…”

Section: Discussionmentioning

confidence: 99%

“…This review also has the highest statistical power and appraises all the clinically important endpoints. The most recent reviews by Zhou et al in 2020 included 11 studies with 1107 patients [21]; other reviews by Bahbah et al in 2019 and Sutherland et al in 2018 included 9 RCTs with 1572 patients, and 14 trials with 1917 participants, respectively [22,23]. This For studies reporting on HEC patients, olanzapine is statistically and clinically superior in seven of nine efficacy endpoints in the prophylaxis setting; only complete emetic control in the acute and overall phases were not statistically different from comparative regimens.…”

Section: Discussionmentioning

confidence: 99%

“…A number of phase III randomized controlled trials were subsequently undertaken and published, and multiple systematic reviews and meta-analyses have been conducted [21][22][23][24][25][26][27]. However, no review has separately analyzed antiemetics for highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC) patients, an important distinction that leads to different clinical guideline recommendations.…”

Section: Introductionmentioning

confidence: 99%

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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

Chow

Herrstedt

Aapro

et al. 2021

Support Care Cancer

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Introduction The aim of this study is to rigorously review the efficacy and safety of olanzapine in defined hematology oncology settings including (1) the setting of highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC) settings (2) at 5 mg and 10 mg doses, and (3) for response rates for use in the acute, delayed, and overall settings post-MEC and HEC. Methods Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched through April 23, 2020. The primary efficacy endpoints were the rate of complete response, in the acute (0-24 h post-chemotherapy), delayed (24-120 h post-chemotherapy), and overall (0-120 h post-chemotherapy) phases. The secondary efficacy endpoints were the rates of no nausea and no emesis, for each phase. Safety endpoints were the rate of no serious adverse events (i.e., no grade 3 or 4 toxicities), as assessed by Common Terminology Criteria for Adverse Events (CTCAE) criteria. The Mantel-Haenszel, random-effects analysis model was used to compute risk ratios and accompanying 95% confidence intervals for each endpoint. For endpoints that statistically favored one arm, absolute risk differences were computed to assess whether there is a 10% or greater difference, used as the threshold for clinical significance by MASCC/ESMO. Fragility indices were also calculated for each statistically significant endpoint, to quantitatively assess the robustness of the summary estimate. A cumulative meta-analysis was conducted for each efficacy meta-analysis with more than 5 studies, also using the Mantel-Haenszel random-effects analysis model. Results Three studies reported on olanzapine for the rescue of breakthrough chemotherapy-induced nausea and vomiting (CINV); 22 studies reported on olanzapine in the prophylactic setting. For studies reporting on HEC patients, olanzapinecontaining regimens were statistically and clinically superior in seven of nine efficacy endpoints in the prophylaxis setting. When olanzapine is administered at a 10-mg dose, it is statistically and clinically superior to control patients in eight of nine endpoints among adults. Olanzapine may be effective in the MEC setting and when administered at 5-mg doses, but the paucity of data leads to notable uncertainty. Conclusion Further RCTs are needed in the setting of MEC patients and administration of olanzapine at a lower 5-mg dose, which may be given to reduce the sedative effect of olanzapine at 10 mg.

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“…Studies on the role of olanzapine in the control of CINV and related meta-analyses [ [22] , [23] , [24] ] have led to the inclusion of this agent as antiemetic in more recent international guidelines. Since the early phase II studies [ [10] , [11] , [12] , 25 ], a number of randomized studies on olanzapine have been reported [ [13] , [14] , [15] , [16] , [17] , 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

A randomized study of olanzapine-containing versus standard antiemetic regimens for the prevention of chemotherapy-induced nausea and vomiting in Chinese breast cancer patients

Park

Lau

et al. 2020

The Breast

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Objectives Chemotherapy-induced nausea and vomiting (CINV) are distressing symptoms. This randomized study evaluated the antiemetic efficacies of standard antiemetic regimen with/without olanzapine. Patients and methods Eligible patients were chemotherapy-naive Chinese breast cancer patients who were planned for (neo)adjuvant doxorubicin/cyclophosphamide. Antiemetic regimen for all studied population included aprepitant, ondansetron and dexamethasone; patients were randomized to Olanzapine (with olanzapine) or Standard arms (without olanzapine). Patients filled in self-reported diaries and completed visual analogue scales for nausea, as well as Functional Living Index-Emesis questionnaires. Blood profiles including fasting glucose and lipids were monitored. Results 120 patients were randomized. In Cycle 1 doxorubicin/cyclophosphamide, the Olanzapine arm had significantly higher rates of “Complete Response” than the Standard arm: 65.0% vs 38.3% in the overall period (p = 0.0035), 70.0% vs 51.7% in the acute period (p = 0.0397) and 92.9% vs 74.2% in the delayed period (p = 0.0254). Olanzapine arm also had significantly higher rates of “No significant nausea” and “No nausea” during all 3 time-frames and better QOL. Similar findings were also revealed throughout multiple cycles. Pre-study abnormalities in glucose and lipids occurred in 39.7% and 34.2% of the studied population respectively; there were no differences in these parameters between the two arms at end-of-study assessment. Conclusion The addition of olanzapine to standard aprepitant-based antiemetic regimen provides clinically meaningful improvement in controlling CINV. This was associated with a positive impact on QOL and tolerable toxicity profiles among Chinese breast cancer patients receiving doxorubicin/cyclophosphamide chemotherapy. Further studies on metabolic profiles of breast cancer patients are warranted.

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Olanzapine for the prevention and treatment of cancer-related nausea and vomiting in adults

Abstract: Analysis 5.7. Comparison 5 Olanzapine vs dexamethasone, Outcome 7 No delayed nausea (1-5 days after chemotherapy). Analysis 5.8. Comparison 5 Olanzapine vs dexamethasone, Outcome 8 No delayed vomiting (1-5 days after chemotherapy

Cited by 42 publications

References 61 publications

Orodispersible and transmucosal alternative medications for symptom control in adults

Orodispersible and transmucosal alternative medications for symptom control in adults

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

A randomized study of olanzapine-containing versus standard antiemetic regimens for the prevention of chemotherapy-induced nausea and vomiting in Chinese breast cancer patients

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