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Olanzapine is effective for refractory chemotherapy-induced nausea and vomiting irrespective of chemotherapy emetogenicity

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Abstract

Purpose

The role of olanzapine added to a dopamine antagonist and benzodiazepine for the treatment of refractory chemotherapy-induced nausea and vomiting (CINV) is incompletely characterized in all levels of chemotherapy emetogenicity. This retrospective study evaluated the efficacy of the addition of olanzapine in adults experiencing refractory CINV stratified by chemotherapy emetogenicity.

Methods

Thirty-three adults who experienced CINV refractory to guideline-recommended prophylaxis and breakthrough antiemetics (dopamine antagonists and benzodiazepines) and received at least one dose of olanzapine 5–10 mg per os were evaluated. Failure was defined as >5 emesis events in 24 h or more than 10 cumulative doses of rescue antiemetics following first olanzapine dose per treatment cycle. Post hoc analyses investigated variables impacting olanzapine efficacy.

Results

The addition of olanzapine demonstrated an overall success rate of 70 %. This success rate did not differ between chemotherapy regimens of high versus low-to-moderate emetogenicity (p = 0.79), prophylaxis with serotonin antagonist plus corticosteroid and aprepitant versus serotonin antagonist alone (p = 0.77), or age over 50 versus ≤50 years (p > 0.99). A trend toward greater benefit was seen in women (p = 0.08).

Conclusions

The addition of olanzapine to a dopamine antagonist and benzodiazepine demonstrated high efficacy rates for refractory CINV irrespective of chemotherapy emetogenicity. The high success rates among all groups suggests that incomplete resolution of CINV with prophylactic serotonin antagonists and breakthrough dopamine antagonists plus benzodiazepine may benefit from the addition of olanzapine regardless of gender, degree of chemotherapy emetogenicity, number of prophylactic antiemetics, or age. The trend toward greater control of emesis in women merits further investigation.

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Conflict of interest

No sources of funding were used in the preparation of this article. The authors have no real or apparent conflict of interest to declare.

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Authors and Affiliations

  1. Department of Pharmacy, Highland Park Hospital, NorthShore University HealthSystem, Highland Park, IL, USA

    Sierra Vig

  2. Department of Pharmacy Practice, University of Southern California, School of Pharmacy, Los Angeles, CA, USA

    Laurel Seibert

  3. Department of Pharmacy, University of Arizona Medical Center, Tucson, AZ, USA

    Myke R. Green

  4. Division of Hematology/Oncology, University of Arizona Cancer Center, 1501 N. Campbell Ave., PO Box 245009, Tucson, AZ, 85724-5009, USA

    Myke R. Green

Authors
  1. Sierra Vig
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  2. Laurel Seibert
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  3. Myke R. Green
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Correspondence to Myke R. Green.

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Vig, S., Seibert, L. & Green, M.R. Olanzapine is effective for refractory chemotherapy-induced nausea and vomiting irrespective of chemotherapy emetogenicity. J Cancer Res Clin Oncol 140, 77–82 (2014). https://doi.org/10.1007/s00432-013-1540-z

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  • DOI: https://doi.org/10.1007/s00432-013-1540-z

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