Efficacy of olanzapine for the prophylaxis and rescue of chemotherapy-induced nausea and vomiting (CINV): a systematic review and meta-analysis
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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.
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.
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.
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.
KeywordsOlanzapine Chemotherapy-induced nausea and vomiting Breakthrough emesis Prophylaxis Efficacy
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.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
- 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):1285–1291CrossRefPubMedGoogle 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):349–355Google 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)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 OncologyGoogle Scholar
- 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):542–550CrossRefGoogle Scholar
- 17.Wang X, Wang L (2012) Effectiveness of olanzapine in prevention of chemotherapy induced nausea and vomiting. Clin J Clin (Electron Ed) 6:7406–7407Google 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 13:452–454Google Scholar
- 19.Lu YL et al (2013) Antiemetic effect of low dose olanzapine in solid tumor chemotherapy. Clin J Cancer Prev Treat 20:544–554Google 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 SocietyGoogle Scholar
- 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 OncologyGoogle Scholar
- 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 CancerGoogle Scholar
- 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 1–3Google 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):3090–3098CrossRefPubMedGoogle 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):1000–1006CrossRefPubMedGoogle 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 2013Google 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):456–485Google Scholar
- 33.Kane J, Stefan L, Carpenter D, Docherty J (2003) Introduction: methods, commentary, and summary. J Clin Psychiatr 64(suppl 12):5–19Google Scholar
- 34.Nemeroff CB (1997) Dosing the antipsychotic medication olanzapine. J Clin Psychiatr 58(suppl 10):45–9Google Scholar
- 35.Hale AS (1997) Olanzapine. Br J Hosp Med 58:443–445Google Scholar
- 38.National Comprehensive Cancer Network (2014) NCCN guidelines version 1.2014 www.nccn.org. Accessed 7 July 2015Google Scholar