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Antiemetic use of olanzapine in patients with advanced cancer: results from an open-label multicenter study

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Abstract

Introduction

The antipsychotic drug olanzapine is effective against chemotherapy-induced nausea and targets multiple receptors known to be involved in the emetic reflex arch. The drug has a mean half-life of 30 h, which allows for a single daily administration and is therefore of interest in patients with advanced cancer suffering from nausea.

Objectives

To investigate the antiemetic effect and tolerability of olanzapine in patients with advanced cancer not receiving chemotherapy or irradiation.

Methods

Patients with advanced cancer (no curable treatment options) with at least “moderate” nausea and/or one emetic episode within the last 24 h were included if they had not received chemotherapy or irradiation (last 2 weeks) and had no reversible causes of nausea/vomiting. Patients were administered 10 mg olanzapine daily for 5 days (the first day subcutaneously and the following 4 days orally). Nausea, vomiting, and adverse effects were assessed daily for 7 days. The primary efficacy parameter was nausea after 24 h.

Results

Forty patients from four centers were included and all evaluable after 24 h. Thirty-six patients experienced some degree of improvement. The mean two-item N/V score (0–100) at baseline was 66 and improved to 21 and 24 after 24 h and 7 days, respectively. During the course of the study, the dose of olanzapine was reduced in three patients due to adverse events. Five patients were withdrawn from the study primarily due to progression of malignant disease or per patient’s request.

Conclusions

Olanzapine appears effective and tolerable as an antiemetic in patients with advanced cancer. Future research should examine a lower dose (5 or 2.5 mg), preferably in a randomized controlled trial.

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Author information

Authors and Affiliations

  1. Department of Oncology, Odense University Hospital, Sdr Boulevard 29, Dk-5000, Odense C, Denmark

    Signe Harder

  2. Institute of Clinical Research, University of Southern Denmark, Odense, Denmark

    Signe Harder

  3. OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark

    Signe Harder

  4. Department of Palliative Medicine, The Research Unit, Bispebjerg and Frederiksberg Hospitals, Copenhagen, Denmark

    Mogens Groenvold & Karin Bruun Frandsen

  5. Department of Public Health, University of Copenhagen, Copenhagen, Denmark

    Mogens Groenvold

  6. Department of Oncology, Palliative Team, Odense University Hospital, Odense C, Denmark

    Jesper Isaksen

  7. The Palliative Care Team, Hospital of Southwest Jutland, Esbjerg, Denmark

    Jarl Sigaard & Lise Mondrup

  8. Palliative Care Team, Aarhus University Hospital, Aarhus, Denmark

    Mette Asbjoern Neergaard

  9. Department of Clinical Oncology, Zealand University Hospital, Roskilde, Denmark

    Jørn Herrstedt

  10. Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark

    Jørn Herrstedt

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  1. Signe Harder
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Correspondence to Signe Harder.

Ethics declarations

Permissions from the Danish Medicines Agency and the Local Ethics Committee were obtained before initiation of the study. No study procedures were initiated before a written informed consent had been signed by the patient.

Conflict of interest

This study received funding from the Danish Cancer Society, the IMK Foundation, and Odense University Hospital. The funding sources had no influence on design, conduction, analyses of results, or manuscript writing. The authors declare no conflicts of interest.

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Harder, S., Groenvold, M., Isaksen, J. et al. Antiemetic use of olanzapine in patients with advanced cancer: results from an open-label multicenter study. Support Care Cancer 27, 2849–2856 (2019). https://doi.org/10.1007/s00520-018-4593-3

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  • DOI: https://doi.org/10.1007/s00520-018-4593-3

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