Olanzapine is effective for the treatment of breakthrough chemotherapy-induced nausea and vomiting (CINV) in patients undergoing hematopoietic stem cell transplantation (HSCT), according to a study published in the journal Supportive Care in Cancer.1
Because there is limited evidence to guide the treatment of CINV in patients receiving HSCT who are refractory to prophylactic antiemetic agents, researchers sought to compare the effectiveness of olazapine, palonosetron, and ondansetron in this poorly studied treatment setting.
For the prospective, open-label, phase 2 study, researchers enrolled 62 patients and randomly assigned them to receive ondansetron alone, olanzapine plus ondansetron, or palonosetron alone. All patients were allowed to receive rescue medications as well.
Results showed that 6%, 45%, and 18% of patients who received ondansetron, olanzapine plus ondansetron, and palonosetron, respectively, achieved the primary end point, defined as no emesis, no use of rescue medication, and a nausea score reduction of 50% or greater, at 24 hours after initiation of treatment.
At 48 hours, 6% of patients who received ondansetron, 64% of those given the combination, and 18% who had palonosetron reached the primary end point.
Researchers also found that at 24 hours, 17%, 60%, and 62% achieved a nausea score reduction of 50% or greater for the ondansetron vs olanzapine vs palonosetron groups; 35%, 71%, and 43% achieved this outcome at 48 hours after treatment initiation.
1. Nakagaki M, Barras M, Curley C, Butler JP, Kennedy GA. A randomized trial of olanzapine versus palonosetron versus infused ondansetron for the treatment of breakthrough chemotherapy-induced nausea and vomiting in patients undergoing hematopoietic stem cell transplantation. Supp Care Cancer. 2016 Oct 13. doi: 10.1007/s00520-016-3445-2. [Epub ahead of print]