Olanzapine: The Game-Changer “Antiemetic”

Manikandan Dhanushkodi

doi:10.4103/ijmpo.ijmpo_151_19

Indian Journal of Medical and Paediatric Oncology, Table of Contents

CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2019; 40(02): 274-276
DOI: 10.4103/ijmpo.ijmpo_151_19

Drug Review

Olanzapine: The Game-Changer “Antiemetic”

Authors

Manikandan Dhanushkodi

Department of Medical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India

Abstract

Chemotherapy-induced nausea and vomiting (CINV) is significantly debilitating and worsens the quality of life. Olanzapine, an atypical antipsychotic drug, also has an antiemetic potential. Studies have shown that olanzapine-based regimens have similar efficacy as compared to aprepitant in patients receiving highly emetogenic chemotherapy (HEC). National Comprehensive Cancer Network guidelines also recommends olanzapine-based regimen in HEC. Olanzapine, palonosetron, dexamethasone regimen is a cost-effective option in resource-limited settings in patients receiving HEC.

Keywords

Chemotherapy-induced nausea and vomiting - highly emetogenic chemotherapy - olanzapine

Full Text

References

References
1 Homburger F, Smithy G. Chlorpromazine in patients with nausea and vomiting due to advanced cancer. N Engl J Med 1954; 251: 820-2
2 Janssen PA, Niemegeers CJ, Schellekens KH. Chemistry and pharmacology of compounds related to 4-(4-hydroxy-4-phenyl-piperidino)-butyrophenone. III. Duration of antiemetic action and oral effectiveness of haloperidol (R 1625) and of chlorpromazine in dogs. Arzneimittelforschung 1960; 10: 955
3 Fuller RW, Snoddy HD. Neuroendocrine evidence for antagonism of serotonin and dopamine receptors by olanzapine (LY170053), an antipsychotic drug candidate. Res Commun Chem Pathol Pharmacol 1992; 77: 87-93
4 Moore NA, Tye NC, Axton MS, Risius FC. The behavioral pharmacology of olanzapine, a novel “atypical” antipsychotic agent. J Pharmacol Exp Ther 1992; 262: 545-51
5 Baldwin DS, Montgomery SA. First clinical experience with olanzapine (LY 170053): Results of an open-label safety and dose-ranging study in patients with schizophrenia. Int Clin Psychopharmacol 1995; 10: 239-44
6 Pirl WF, Roth AJ. Remission of chemotherapy-induced emesis with concurrent olanzapine treatment: A case report. Psychooncology 2000; 9: 84-7
7 Navari RM, Qin R, Ruddy KJ, Liu H, Powell SF, Bajaj M. et al. Olanzapine for the prevention of chemotherapy-induced nausea and vomiting. N Engl J Med 2016; 375: 134-42
8 Shivaprakash G, Udupa KS, Sarayu V, Thomas J, Gupta V, Pallavi LC. et al. Olanzapine versus aprepitant for the prophylaxis of chemotherapy-induced nausea and vomiting in breast cancer patients receiving doxorubicin-cyclophosphamide regimen: A prospective, nonrandomized, open-label study. Indian J Pharmacol 2017; 49: 451-7
9 Mehra N, Ganesan P, Ganesan TS, Veeriah S, Boopathy A, Radhakrishnan V. et al. Effectiveness of olanzapine in patients who fail therapy with aprepitant while receiving highly emetogenic chemotherapy. Med Oncol 2017; 35: 12
10 Mehra N, Ganesan P, Dhanushkodi M, Ganesan TS, Radhakrishnan V, Jayachandran PK. et al. An effective anti-emetic regimen for less than $2 USD: A prospective observational study. J Clin Oncol 2018; 36: e22194-4
11 Jeon SY, Han HS, Bae WK, Park MR, Shim H, Lee SC. et al. A randomized, double-blind, placebo-controlled study of the safety and efficacy of olanzapine for the prevention of chemotherapy-induced nausea and vomiting in patients receiving moderately emetogenic chemotherapy: Results of the Korean South West Oncology Group (KSWOG) study. Cancer Res Treat 2019; 51: 90-7
12 Yang T, Liu Q, Lu M, Ma L, Zhou Y, Cui Y. et al. Efficacy of olanzapine for the prophylaxis of chemotherapy-induced nausea and vomiting: A meta-analysis. Br J Clin Pharmacol 2017; 83: 1369-79
13 Yokoe T, Hayashida T, Nagayama A, Nakashoji A, Maeda H, Seki T. et al. Effectiveness of antiemetic regimens for highly emetogenic chemotherapy-induced nausea and vomiting: A systematic review and network meta-analysis. Oncologist 2019; 24: e347-57
14 Ruhlmann CH, Christensen TB, Dohn LH, Paludan M, Rønnengart E, Halekoh U. et al. Efficacy and safety of fosaprepitant for the prevention of nausea and emesis during 5 weeks of chemoradiotherapy for cervical cancer (the GAND-emesis study): A multinational, randomised, placebo-controlled, double-blind, phase 3 trial. Lancet Oncol 2016; 17: 509-18
15 Aapro M, Rugo H, Rossi G, Rizzi G, Borroni ME, Bondarenko I. et al. A randomized phase III study evaluating the efficacy and safety of NEPA, a fixed-dose combination of netupitant and palonosetron, for prevention of chemotherapy-induced nausea and vomiting following moderately emetogenic chemotherapy. Ann Oncol 2014; 25: 1328-33
16 Navari RM, Rapoport BL, Powers D, Arora S, Clark-Snow R. Rolapitant for the prevention of nausea in patients receiving highly or moderately emetogenic chemotherapy. Cancer Med 2018; 7: 2943-2950
17 Navari RM, Gray SE, Kerr AC. Olanzapine versus aprepitant for the prevention of chemotherapy-induced nausea and vomiting: A randomized phase III trial. J Support Oncol 2011; 9: 188-95
18 Tan L, Liu J, Liu X, Chen J, Yan Z, Yang H. et al. Clinical research of olanzapine for prevention of chemotherapy-induced nausea and vomiting. J Exp Clin Cancer Res 2009; 28: 131
19 Chanthawong S, Lim YH, Subongkot S, Chan A, Andalusia R, Bustamam RS. et al. Cost-effectiveness analysis of olanzapine-containing antiemetic therapy for managing highly emetogenic chemotherapy in Southeast Asia: A multinational study. Support Care Cancer 2019; 27: 1109-19