Cancer and chemotherapy-induced nausea and vomiting: a focus on olanzapine

Purpose of the review: The purpose of review is to critically present the evidence supporting the use of olanzapine, an atypical antipsychotic, as an antiemetic for cancer and chemotherapy-induced nausea and vomiting (CINV). Recent findings: Two phase III clinical studies demonstrated superior efficacy of olanzapine in comparison with the neurokinin-1 receptor antagonists (NK1RA) for substance P (aprepitant, fosaprepitant) in the prevention of nausea after highly emetogenic chemotherapy. Olanzapine is inexpensive and the replacement of NK1RA with olanzapine can reduce the costs of the prevention of CINV. The addition of olanzapine to aprepitant-containing combination regimens for the prevention of CINV was also investigated, and has the potential to further improve the prevention of CINV after highly emetogenic chemotherapy or moderately emetogenic chemotherapy, without substantial increase in costs. In the treatment of uncontrolled (’breakthrough’) CINV, olanzapine was more effective than metoclopramide. Existing clinical data also support the use of olanzapine to relieve a cluster of gastrointestinal symptoms in patients with advanced cancer (chronic nausea, vomiting, and anorexia). When used in cancer patients, olanzapine is well tolerated, with sedation being the major dose-limiting side effect. Summary: Existing data from clinical trials justify further research of the role of olanzapine in the prevention of CINV. Olanzapine may be used instead of or in addition to...
Source: Current Opinion in Supportive and Palliative Care - Category: Palliative Care Tags: GASTROINTESTINAL SYMPTOMS: Edited by Rachel J. Gibson and Matthew A. Ciorba Source Type: research