Randomized Phase II Trial to Compare the Efficacy of Haloperidol and Olanzapine in the Control of Chemotherapy-Induced Nausea and Vomiting in Nepal

Dulal, Soniya; Paudel, Bishnu Dutta; Neupane, Prakash; Shah, Aarati; Acharya, Bibek; Poudyal, Bishesh Sharma; Shilpakar, Ramila; Wood, Lori

doi:10.1200/jgo.18.00245

Cited by 6 publications

(9 citation statements)

References 20 publications

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“…6 Both typical and atypical antipsychotics are classes of drugs frequently used for CINV. 8,16,17 The American Society of Clinical Oncology included olanzapine in their 2017 treatment guidelines as a prophylactic agent in highly emetogenic chemotherapy. 16 In a 2019 phase II clinical trial, olanzapine was found to have efficacy similar to haloperidol in the treatment of CINV.…”

Section: Discussionmentioning

confidence: 99%

“…16 In a 2019 phase II clinical trial, olanzapine was found to have efficacy similar to haloperidol in the treatment of CINV. 17 However, while haloperidol is more commonly utilized as an antiemetic, the only other case series reporting on the use of olanzapine in CHS found that haloperidol was less effective than olanzapine. 11 Olanzapine is a histaminergic, dopaminergic, serotonergic, and muscarinic antagonist which may explain its antiemetic properties.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of Cannabinoid Hyperemesis With Olanzapine: A Case Series

Hsu

Herrmann²,

Kashyap³

et al. 2021

Journal of Psychiatric Practice

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The use and availability of cannabis for recreational and medical purposes has become more widespread with increased legalization. Adverse health outcomes of this increased use include cannabinoid hyperemesis syndrome (CHS), which is underrecognized in medical settings. Cessation of substance use is the recommendation of choice for the complete resolution of CHS. However, interventions that provide rapid relief may be necessary in treatment-refractory cases. Little evidence is available to guide care in these cases. Here we report 4 cases of treatment-refractory CHS, all of which remitted after treatment with olanzapine. Olanzapine is known to block multiple neurotransmitter receptors involved in nausea and vomiting in chemotherapy-induced nausea and vomiting. Outcomes of the cases reported here suggest that off-label use of olanzapine may be effective in the symptomatic treatment of refractory CHS and may be the preferred treatment in cases in which comorbid psychotic symptoms or agitation are present.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatment of Cannabinoid Hyperemesis With Olanzapine: A Case Series

Hsu

Herrmann²,

Kashyap³

et al. 2021

Journal of Psychiatric Practice

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“…Recent studies have investigated the use of olanzapine as an antiemetic drug (AED) in adult patients undergoing chemotherapy. The findings revealed an effective antiemetic effect compared with aprepitant or metoclopramide and other combinations of AEDs [9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 93%

Efficacy of Olanzapine for High and Moderate Emetogenic Chemotherapy in Children

Lee

Kim

et al. 2020

Children

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This study was conducted to investigate the safety and efficacy of olanzapine for high and moderate emetogenic chemotherapy in children and young adults. We retrospectively reviewed the records of pediatric patients (n = 13) with cancer who had been administered olanzapine as an anti-emetic drug (AED) during a high and moderate emetogenic chemotherapy block from January 2018 to March 2020. Patients were administered other prophylactic AEDs according to practice guidelines. The mean age of the patients was 14.1 ± 5.5 years. The total number of chemotherapy cycles was 41. Twenty-one (51.2%) chemotherapy blocks were high emetogenic chemotherapy and 20 (48.8%) blocks were moderate emetogenic chemotherapy. Olanzapine was used for prophylaxis in 20 (48.8%) blocks of chemotherapy and rescue in 21 (51.2%). Of the 41 cycles, a complete response to olanzapine was achieved in 31 (75.6%), partial response in 6 (14.6%), and no response in 4 (9.8%). The mean dose was 0.07 ± 0.04 mg/kg/dose and 2.50 ± 1.37 mg/m2/dose. Adverse effects included somnolence, hyperglycemia, fatigue, and disturbed sleep. Our findings indicate that olanzapine was effective and safe for treating chemotherapy-induced nausea and vomiting in children. A prospective controlled study is needed to confirm these findings.

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“…Among the adult prophylactic studies, 15 reported exclusively on HEC patients [46, 49-52, 55, 56, 58, 60-66], three exclusively on MEC patients [53,57,59], and three on a patient population that consists of both HEC and MEC patients [45,47,54]. Eight studies compared olanzapine to a double-blind placebo-controlled regimen [47,52,59,[62][63][64][65][66] and thirteen used an opened controlled study design-nine studies used a control arm with antiemetics different from the antiemetics in the investigational (olanzapine-containing) arm [46,49,51,53,55,56,58,60,61] and four used a control arm with the same antiemetics as in the investigational (olanzapinecontaining) arm except for olanzapine [45,50,54,57]. 17 adult prophylactic studies used 10 mg doses of olanzapine [45, 46, 49-59, 61, 62, 65, 66], and 3 studies used 5 mg [47,60,63]; 1 used a mix of 5 mg and 10 mg [64] (Table 1).…”

Section: Included Studiesmentioning

confidence: 99%

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

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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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Randomized Phase II Trial to Compare the Efficacy of Haloperidol and Olanzapine in the Control of Chemotherapy-Induced Nausea and Vomiting in Nepal

Cited by 6 publications

References 20 publications

Treatment of Cannabinoid Hyperemesis With Olanzapine: A Case Series

Treatment of Cannabinoid Hyperemesis With Olanzapine: A Case Series

Efficacy of Olanzapine for High and Moderate Emetogenic Chemotherapy in Children

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

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