Kailash Kumar Mittal1, Parveen Mendiratta2, Nishu Bala3
BACKGROUND
Chemotherapy-induced nausea and vomiting (CINV) is a frequent and feared
adverse effect of cancer chemotherapy. International guidelines recommend
combinations of 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists,
dexamethasone, and/or neurokinin-1 (NK1) receptor antagonists for the control of
CINV in patients receiving highly emetogenic chemotherapy (HEC) as a part of
their treatment. Even though, nausea in delayed period is less controlled and poses
a major concern for these patients.
METHODS
This open label, prospective study was conducted in a rural medical college in
Etawah District in Uttar Pradesh, India from November 2017 to November 2018
over a period of 1 year to observe the efficacy of low dose (5 mg OD) olanzapine
in combination with standard anti-emetic regimen for the prevention of CINV.
Olanzapine is a food and drug administration (FDA) approved antipsychotic drug
that has anti-emetic activity and has shown to improve CINV. Low dose olanzapine
along with a standard combination of ondansetron, dexamethasone and aprepitant
was given to patients receiving highly emetogenic chemotherapy (Cisplatin >70
mg/m2 or doxorubicin-cyclophosphamide combination). CINV was assessed using
common toxicity criteria of adverse events (CTCAE) version 5.0.
RESULTS
Complete response to nausea was observed in 90.90 %, 60.60 % and 54.54 % in
acute, delayed and overall period respectively. Complete response to vomiting was
observed in 96.96 %, 69.69 % and 66.66 % in acute, delayed and overall period
respectively. Complete response to Grade-2 (or above) nausea was observed in
96.96 %, 93.93 % and 90.90 % in acute, delayed and overall period, respectively.
Daytime Grade -3 somnolence which was seen in 2/33 patients (6.06 %) was
attributable to olanzapine. Patients receiving olanzapine were more likely to have
complete response of nausea and emesis in the early, late, and overall assessment
periods especially of higher grade (G2 and G3).
CONCLUSIONS
The authors concluded that low dose olanzapine 5 mg OD combined with an NK1-
receptor antagonist, a 5-HT3–receptor antagonist, and dexamethasone is safe and
efficacious in the prevention of CINV in patients receiving HEC.
