Olanzapine for the Prevention and Treatment of Chemotherapy-Induced Nausea and Vomiting: A Review to Identify the Best Way to Administer the Drug

Abstract

Common treatment methods for malignant tumors include surgery, chemotherapy, radiotherapy, immunotherapy, targeted therapy, etc., among which chemotherapy plays an important role. However, chemotherapy brings corresponding side effects while killing tumor cells, and nausea and vomiting are the most common adverse reactions induced by chemotherapy. It not only affects the patient’s appetite, resulting in malnutrition and electrolyte disturbances, but also reduces the patient’s compliance with treatment, which further aggravates the disease. Thus, it is important to quickly prevent and cure nausea and vomiting induced by chemotherapy (CINV). In addition, with the continuous development of medicine, more and more antiemetic drugs have been developed. At present, the most common antiemetic agents for chemotherapy-induced nausea and vomiting are NK-1R antagonists, 5-HT3R antagonists, and dexamethasone. Surprisingly, olanzapine, often used as a psychotropic drug, has been found to be an effective antiemetic and is similar to other regimens on the safety of medicine. However, although there are numerous studies on the antiemetic effects of olanzapine, its comprehensive application remains unclear. Therefore, this review will elaborate the antiemetic effect of olanzapine in terms of the antiemetic mechanism and the safety, economic cost, dose, administration time, and drug delivery aspects.

Does an Antipsychotic Hold the Key to Nausea Treatment in Cancer Patients? A Review on the Anti-Nausea Effects of Olanzapine in Oncology

“…Two options for treating cancer are chemotherapy and radiation therapy (RT), and they induce nausea and vomiting via different mechanisms. Chemotherapy has the astonishing ability to stunt the growth of a tumour or even kill it, but not without killing nearby normal cells, causing a wide array of adverse effects 10 . Chemotherapy induced nausea and vomiting (CINV) occurs when serotonin (5HT-3) receptors located in the upper gastrointestinal region become stimulated, thus causing stimulation of the vomiting center located in the medulla oblongata, along with the stimulation of neurokinin-1 (NK-1) and dopamine (D2) receptors found in the chemoreceptor trigger zone 6,11 .…”

“…Knowing the causative agents behind CINV means that treatment can target these receptors via blockade of serotonin, dopamine, and substance P 11 . It is of significance to note that CINV can be classified as either acute (which occurs up to 24 hours after chemotherapy is administered) or delayed (which occurs on the second day of treatment and can last up to seven days) 1,10 . Nausea and vomiting involve three phases, including pre-ejection, retching, and ejection of vomitus 12 .…”

“…Because olanzapine has a background in psychiatry 10,[12][13][14] , it is prudent to also comment on the possible relationship between mental health and cancer-related nausea and vomiting. Pain and anxiety commonly interplay between each other, with pain being a common feature in cancer, whether it be caused by physical causes such as metastasis, RT, or chemotherapy 1,6 , or psychosocial causes such as social exclusion, existential fears, or reduced quality of life 9 .…”

“…Olanzapine works via a variety of mechanisms, and is known to be an atypical second-generation thienobenzodiazepine antipsychotic 10,12 with blockade of dopamine (D1, D2, D3, D4 receptors) and serotonin (5-HT2a, 5-HT2c, 5-HT3, 5-HT6) [12][13][14] , the former of which (specifically the D2 and D3 receptors) exerts its antinausea properties in the postrema region 6 , and together purported to work on the chemoreceptor trigger zone (CTZ) and vomiting center of the brain 24 . Olanzapine also works via the blockade of catecholamines at alpha1 adrenergic receptors (α1), acetylcholine at muscarinic receptors, (M1, M2, M3, M4) and histamine at H1 receptors [12][13][14] .…”

“…Hepatic metabolism occurs via the mechanisms of glucuronidation and oxidative metabolism 6 . Olanzapine has a bioavailability of 85%, with a half-life of between 21 hours and 60 hours and a peak plasma concentration of approximately four to six hours 6,10 .…”