Skip to main content

Advertisement

SpringerLink
Log in

Efficacy of olanzapine for the prophylaxis and rescue of chemotherapy-induced nausea and vomiting (CINV): a systematic review and meta-analysis

  • Review Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Olanzapine is a potent antipsychotic medication that inhibits a wide variety of receptors. It has been used in trials for the prophylaxis and rescue of chemotherapy-induced nausea and vomiting (CINV). This study systematically investigates the efficacy of olanzapine in relation to other antiemetics in the prophylaxis and rescue of CINV.

Methods

A literature search of Ovid MEDLINE, EMBASE, and CENTRAL was conducted to identify randomized controlled trials (RCTs) comparing olanzapine to other standard antiemetics for either prevention or rescue. The primary endpoints were the percentage of patients achieving no emesis or no nausea, in the acute, delayed, and overall phases.

Results

Ten RCTs in the preventative setting and three RCTs in the breakthrough setting were identified. Subgroup analysis demonstrated a similar degree of benefit from a 5- and 10-mg dose of olanzapine for the no emesis endpoint in the overall phase. In the prophylaxis setting, olanzapine was statistically superior in five of six endpoints and clinically superior in four of six endpoints. In the breakthrough setting, olanzapine was statistically and clinically superior in the only endpoint analyzed: no emesis.

Conclusion

Olanzapine is more efficacious than other standard antiemetics for the rescue of CINV and its inclusion improves control in the prevention setting. Given the possible reduction in side effects, the use of a 5-mg dose of olanzapine should be considered. Future RCTs should compare the 5-mg versus the 10-mg dosages further and report on the efficacy and percentage of patients developing side effects. Further analyses should be done without the influence of corticosteroids.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Osoba D, Zee B, Warr D, Latreille J, Kaizer L, Pater J (1997) Effect of postchemotherapy nausea and vomiting on health-related quality of life. Support Care Cancer 5(4):307–313

    Article  CAS  PubMed  Google Scholar 

  2. Basch E, Prestrud AA, Hesketh PJ et al (2011) Antiemetic American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 29:4189–98

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hocking CM, Kichenadasse G (2014) Olanzapine for chemotherapy-induced nausea and vomiting: a systematic review. Support Care Cancer 22(4):1143–1151

    Article  PubMed  Google Scholar 

  4. Srivastava M, Brito-Dellan N, Davis MP, Leach M, Lagman R (2003) Olanzapine as an antiemetic in refractory nausea and vomiting in advanced cancer. J Pain Symptom Manag 25(6):578–582

    Article  Google Scholar 

  5. Navari RM, Einhorn LH, Passik SD, Loehrer PJ, Johnson C, Mayer ML et al (2005) A phase II trial of olanzapine for the prevention of chemotherapy-induced nausea and vomiting: a Hoosier Oncology Group study. Support Care Cancer 13(7):529–534

    Article  PubMed  Google Scholar 

  6. Passik SD, Navari RM, Jung SH, Nagy C, Vinson J, Kirsh KL et al (2004) A phase I trial of olanzapine (Zyprexa) for the prevention of delayed emesis in cancer patients: a Hoosier Oncology Group study. Cancer Investig 22(3):383–388

    Article  CAS  Google Scholar 

  7. Passik SD, Kirsh KL, Theobald DE, Dickerson P, Trowbridge R, Gray D et al (2003) A retrospective chart review of the use of olanzapine for the prevention of delayed emesis in cancer patients. J Pain Symptom Manag 25(5):485–488

    Article  Google Scholar 

  8. Passik SD, Lundberg J, Kirsh KL, Theobald D, Donaghy K, Holtsclaw E et al (2002) A pilot exploration of the antiemetic activity of olanzapine for the relief of nausea in patients with advanced cancer and pain. J Pain Symptom Manag 23(6):526–532

    Article  CAS  Google Scholar 

  9. Navari RM, Einhorn LH, Loehrer PJ, Passik SD, Vinson J, McClean J et al (2007) A phase II trial of olanzapine, dexamethasone, and palonosetron for the prevention of chemotherapy-induced nausea and vomiting: a Hoosier oncology group study. Support Care Cancer 15(11):1285–1291

    Article  PubMed  Google Scholar 

  10. Chanthawong S, Subongkot S, Sookprasert A (2014) Effectiveness of olanzapine for the treatment of breakthrough chemotherapy induced nausea and vomiting. J Med Assoc Thail = Chotmaihet Thangphaet 97(3):349–355

    Google Scholar 

  11. Tan L, Liu J, Liu X, Chen J, Yan Z, Yang H, Zhang D (2009) Clinical research of olanzapine for prevention of chemotherapy-induced nausea and vomiting. J Exp Clin Cancer Res 28:131

    Article  PubMed  PubMed Central  Google Scholar 

  12. Shumway NM, Terrazzino SE, Jones CB (2009) A randomized pilot study comparing aprepitant to olanzapine for treatment of chemotherapy-induced nausea and vomiting. J Clin Oncol: Ann ASCO Meet 27(15)

  13. Navari RM, Nagy CK, Gray SE (2013) The use of olanzapine versus metoclopramide for the treatment of breakthrough chemotherapy induced nausea and vomiting in patients receiving highly emetogenic chemotherapy. Support Care Cancer 21(6):1655–1663

    Article  PubMed  Google Scholar 

  14. Navari RM, Gray SE, Kerr AC (2011) Olanzapine versus aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a randomized phase III trial. J Support Oncol 9(5):188–195

    Article  CAS  PubMed  Google Scholar 

  15. Navari RM, Gray SE (2009) Treatment of chemotherapy-induced breakthrough nausea and vomiting. Conference publication: 2009 annual meeting of the American Society of Clinical Oncology

  16. Mizukami N, Yamauchi M, Koike K, Watanabe A, Ichihara K, Masumori N et al (2014) Olanzapine for the prevention of chemotherapy-induced nausea and vomiting in patients receiving highly or moderately emetogenic chemotherapy: a randomized, double-blind, placebo-controlled study. J Pain Symptom Manag 47(3):542–550

    Article  Google Scholar 

  17. Wang X, Wang L (2012) Effectiveness of olanzapine in prevention of chemotherapy induced nausea and vomiting. Clin J Clin (Electron Ed) 6:7406–7407

    Google Scholar 

  18. Mao WK, Peng L (2011) Clinical observation of Olanzapine combined with Granisetrom and Hexadecadrol prevent nausea vomit induced by chemoradiotherapy. Chin J Med Guid 13:452–454

    Google Scholar 

  19. Lu YL et al (2013) Antiemetic effect of low dose olanzapine in solid tumor chemotherapy. Clin J Cancer Prev Treat 20:544–554

    Google Scholar 

  20. Navari RM, Gray S (2010) Treatment of chemotherapy-induced breakthrough nausea and vomiting. Conference publication: 7th annual conference of the American Psychosocial Oncology Society

  21. Navari RM, Nagy CK (2015) Olanzapine versus fosaprepitant for the prevention of nausea and vomiting in patients receiving concurrent chemo-radiation treatment. Conference publication: 2015 annual meeting of the American Society of Clinical Oncology

  22. Mukhopadhyay S, Kwartra G, Jeyaraj P, Badyal D (2015) Role of olanzapine in chemotherapy induced nausea and vomiting on platinum based chemotherapy patients: a randomized controlled study. Conference publication: MASCC/ISOO Annual Meeting on Supportive Care in Cancer

  23. Wang X, Wang L, Wang H, Zhang H (2015) Effectiveness of olanzapine combined with ondansetron in prevention of chemotherapy-induced nausea and vomiting of non-small cell lung cancer. Cell Biochem Biophys 1–3

  24. Wang XF, Feng Y, Chen Y, Gao BL, Han BH (2014) A meta-analysis of olanzapine for the prevention of chemotherapy-induced nausea and vomiting. Sci Rep 4:4813

    PubMed  PubMed Central  Google Scholar 

  25. Roila F, Herrstedt J, Aapro M et al (2010) Guideline update for MASCC and ESMO in the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting: results of the Perugia consensus conference. Ann Oncol 21(Suppl 5):v232–v243

    Article  PubMed  Google Scholar 

  26. Poli-Bigelli S, Rodrigues-Pereira J, Carides AD, Julie Ma G, Eldridge K, Hipple A, Evans JK, Horgan KJ, Lawson F, Aprepitant Protocol 054 Study G (2003) Addition of the neurokinin 1 receptor antagonist aprepitant to standard antiemetic therapy improves control of chemotherapy-induced nausea and vomiting. Results from a randomized, double-blind, placebo-controlled trial in Latin America. Cancer 97(12):3090–3098

    Article  CAS  PubMed  Google Scholar 

  27. Schmoll HJ, Aapro MS, Poli-Bigelli S, Kim HK, Park K, Jordan K, von Pawel J, Giezek H, Ahmed T, Chan CY (2006) Comparison of an aprepitant regimen with a multiple-day ondansetron regimen, both with dexamethasone, for antiemetic efficacy in high-dose cisplatin treatment. Ann Oncol 17(6):1000–1006

    Article  CAS  PubMed  Google Scholar 

  28. Aapro M, Rossi G, Rizzi G, Palmas M, Grunberg S (2013) Phase III study of NEPA, a fixed-dose combination of netupitant (NETU) and palonosetron (PALO), versus PALO for prevention of chemotherapy induced nausea and vomiting (CINV) following moderately emetic chemotherapy (MEC). 2013 ASCO Annual Meeting Abstract LBA9514. Presented June 1st 2013

  29. Cohen L, de Moor CA, Eisenberg P, Ming EE, Hu H (2007) Chemotherapy-induced nausea and vomiting: incidence and impact on patient quality of life at community oncology settings. Support Care Cancer 15(5):497–503

    Article  PubMed  Google Scholar 

  30. Ettinger DS, Armstrong DK, Barbour S, Berger MJ, Bierman PJ, Bradbury B et al (2012) Antiemesis. J Natl Compr Cancer Netw 10(4):456–485

    CAS  Google Scholar 

  31. Bymaster FP, Calligaro D, Falcone J et al (1996) Radioreceptor binding profile of the atypical antipsychotic olanzapine. Neuropsychopharmacology 14:87–96

    Article  CAS  PubMed  Google Scholar 

  32. Fonte C, Fatigoni S, Roila F (2015) A review of olanzapine as an antiemetic in chemotherapy-induced nausea and vomiting and in palliative care patients. Crit Rev Oncol/Hematol 95(2):214–221

    Article  CAS  Google Scholar 

  33. Kane J, Stefan L, Carpenter D, Docherty J (2003) Introduction: methods, commentary, and summary. J Clin Psychiatr 64(suppl 12):5–19

    Google Scholar 

  34. Nemeroff CB (1997) Dosing the antipsychotic medication olanzapine. J Clin Psychiatr 58(suppl 10):45–9

    CAS  Google Scholar 

  35. Hale AS (1997) Olanzapine. Br J Hosp Med 58:443–445

    Google Scholar 

  36. Detke H, McDonnell D, Brunner E et al (2010) Post-injection delirium/sedation syndrome in patients with schizophrenia treated with olanzapine long-acting injection, I: analysis of cases. BMC Psychiatry 10:43

    Article  PubMed  PubMed Central  Google Scholar 

  37. Battaglia J, Lindborg S, Alaka K et al (2003) Calming versus sedative effects of intramuscular olanzapine in agitated patients. Am J Emerg Med 21(3):192–198

    Article  PubMed  Google Scholar 

  38. National Comprehensive Cancer Network (2014) NCCN guidelines version 1.2014 www.nccn.org. Accessed 7 July 2015

Download references

Acknowledgments

We thank the generous support of Bratty Family Fund, Michael and Karyn Goldstein Cancer Research Fund, Joey and Mary Furfari Cancer Research Fund, Pulenzas Cancer Research Fund, Joseph and Silvana Melara Cancer Research Fund, and Ofelia Cancer Research Fund.

Author information

Authors and Affiliations

  1. Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada

    Leonard Chiu, Ronald Chow, Marko Popovic, Nicholas Chiu, Henry Lam, Milica Milakovic, Mark Pasetka, Sherlyn Vuong, Edward Chow & Carlo DeAngelis

  2. Indiana University School of Medicine, South Bend, IN, USA

    Rudolph M. Navari

  3. San Antonio Military Medical Center (SAMMC), San Antonio, TX, USA

    Nathan M. Shumway

  4. Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada, M4N 3M5

    Edward Chow

Authors
  1. Leonard Chiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ronald Chow
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marko Popovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rudolph M. Navari
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nathan M. Shumway
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nicholas Chiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Henry Lam
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Milica Milakovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mark Pasetka
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Sherlyn Vuong
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Edward Chow
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Carlo DeAngelis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Edward Chow.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Appendix

Appendix

Table 5 Absolute risk differences between olanzapine and other prophylactic antiemetic intervention arms for all included chemotherapy-induced nausea and vomiting endpoints
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chiu, L., Chow, R., Popovic, M. et al. Efficacy of olanzapine for the prophylaxis and rescue of chemotherapy-induced nausea and vomiting (CINV): a systematic review and meta-analysis. Support Care Cancer 24, 2381–2392 (2016). https://doi.org/10.1007/s00520-016-3075-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-016-3075-8

Keywords

Search

Navigation