Low dose olanzapine in non-inferior to standard dose in terms of anti-emetic effect in patients receiving emetogenic chemotherapy

1. Low dose Olanzapine (2.5 mg) demonstrated similar anti-emetic effect to standard dose olanzapine in patients receiving emetogenic chemotherapy

2. Patients in the low-dose group experienced significantly fewer instances of daytime somnolence compared to those who received standard dose

Evidence Rating Level: 1 (Excellent)

Study Rundown: The present trial was a single-centered trial that compared the efficacy of low-dose versus standard dose olanzapine in preventing chemotherapy induced nausea and vomiting. The patient population assessed were patients with solid tumor cancers receiving highly emetogenic chemotherapy. These patients were either randomized to receive low-dose (2.5 mg) or standard dose (10mg) olanzapine for four days in combination with a triple antiemetic regimen. Overall, low dose olanzapine was found to be non-inferior to high dose olanzapine in efficacy in achieving complete control of chemotherapy induced nausea and vomiting. Moreover, the rate of daytime somnolence one day 1 of the regimens was significantly lower in the lower dose group. Strengths of this study include its large sample size. Limitations of this study include that the population was predominantly women with breast cancer being treated with anthracycline and cyclophosphamide- based treatments. This limits the generalizability of this study. The study also used a lower dose of steroids than typical in their anti-emetic treatment. This may have resulted in fewer steroid-related adverse events.  The study overall provides evidence supporting a lower dose of olanzapine to control chemotherapy indued nausea in patients undergoing highly emetogenic chemotherapy for solid tumors.

Click to read the study in The Lancet Oncology

Relevant Reading: Olanzapine for the prevention of chemotherapy-induced nausea and vomiting

In-Depth [randomized controlled trial]: The present study was a single-centered, open-labelled trial that compared the anti-emetic effect of low-dose olanzapine (2.5 mg) versus standard dose olanzapine (10 mg) in patients with solid tumor cancers undergoing highly emetogenic chemotherapy. The impact of olanzapine dosing was assessed within a triple antiemetic regimen including an NK-1 receptor agonist, a 5-HT3 receptor antagonist and dexamethasone. Eligibile participants included patients between the age of 13- 75 diagnosed with a solid tumor cancer and receiving highly emetic chemotherapy. All participants had an ECOG score between 0-2. The primary outcome of the trial was complete symptom control of chemotherapy induced nausea defined as no emetic episodes, no use of rescue medications and no to mild nausea. It was noted that those low-dose olanzapine was non-inferior to standard dose olanzapine in terms of complete symptom control (one sided 95% CI- 100 to 9.0; p=0.87). The study also assessed patients in each group for daytime somnolence. They concluded that those in the low-dose olanzapine group had decreased day-time somnolence in compared to those on standard-dose olanzapine as evidence by visual rating scale. Overall, these findings suggest that low-dose as opposed to standard dose olanzapine should be used as part of a triple anti-emetic regimen for anti-emetic treatment in patients with solid tumor cancers undergoing highly emetogenic chemotherapy.

Image: PD

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