OLANZAPINE COMBINED WITH STANDARD ANTIEMETIC REGIMENS FOR PREVENTION OF CHEMOTHERAPY THERAPY-INDUCED NAUSEA AND VOMITING: A SINGLE-CENTER EXPERIENCE FROM SOUTH INDIA
Keywords:Adverse events, Chemotherapy-induced nausea and vomiting, Effectiveness, Olanzapine, Quality of life
Â Objectives: Olanzapine, an antipsychotic agent, exhibits significant antiemetic properties due to its inhibitory activity on neurotransmitters at multiple receptors involved in chemotherapy-induced nausea and vomiting (CINV). CINV can have an immensely negative impact on patient's quality of life (QOL) and daily activities. Our objectives were to determine the effectiveness of adding olanzapine to standard antiemetic regimens for the prevention of CINV in cancer patients and to compare the QOL of such patients with those receiving standard antiemetic regimens.
Methods: A prospective, observational, cohort study was done on patients receiving either highly or moderately emetogenic chemotherapy (MEC). The patients who received only the standard antiemetic regimens were considered as the control group and those who received 10 mg of olanzapine once daily on days 1-5 of chemotherapy in addition to the standard antiemetic regimens were considered to be the study group. The patients were assessed for grades of nausea and vomiting using National Cancer Institute common terminology criteria for adverse events and for QOL using European Organization in Research and Treatment of Cancer QOL questionnaire.
Results: Patients were evaluated for a total of 168 cycles of chemotherapy. Compared to the control group, the study group patients showed significant improvement in response to acute nausea (p=0.02) but not in acute vomiting (p=0.09). However, response to delayed nausea and vomiting improved significantly (p=0.004 and p=0.05, respectively). The QOL of study group patients showed significant improvement in functional scales and symptom scales (p<0.02). Global health status also increased significantly (p=0.02) in the study group patients.
Conclusion: Olanzapine containing pre-medication regimens can reduce acute and delayed nausea and delayed vomiting and improve the QOL of cancer patients receiving highly or moderately emetogenic chemotherapeutic agents as compared to the standard pre-medication regimens.
Bloechl-Daum B, Deuson RR, Mavros P, Hansen M, Herrstedt J. Delayed nausea and vomiting continue to reduce patientsâ€™ quality of life after highly and moderately emetogenic chemotherapy despite antiemetic treatment. J Clin Oncol 2006;24(24):4472-8.
Hilal MA. Chemotherapy induced nausea and vomiting: The role of aprepitant. Middle East J Cancer 2011;2:3-8.
Antony A, Joel JJ, Shetty J, Umar NF. Identification and analysis of adverse drug reactions associated with cancer chemotherapy in hospitalized patients. Int J Pharm Pharm Sci 2016;8:448-51.
Drisya PM, James E. Recent updates in the management of chemotherapy induced nausea and vomiting. Asian J Pharm Clin Res 2013;6 Suppl 4:5-10.
Rusthoven JJ, Osoba D, Butts CA, Yelle L, Findlay H, Grenville A. The impact of postchemotherapy nausea and vomiting on quality of life after moderately emetogenic chemotherapy. Support Care Cancer 1998;6(4):389-95.
Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Intern Med 1993;118(8):622-9.
Ballatori E, Roila F. Impact of nausea and vomiting on quality of life in cancer patients during chemotherapy. Health Qual Life Outcomes 2003;1:1-11.
Drechsler S, Bruntsch U, Eggert J, Grote-Kiehn J, Gosse H, Bangerter M, et al. Comparison of three tropisetron-containing antiemetic regimens in the prophylaxis of acute and delayed chemotherapy-induced emesis and nausea. Support Care Cancer 1997;5(5):387-95.
Feyer P, Jordan K. Update and new trends in antiemetic therapy: The continuing need for novel therapies. Ann Oncol 2011;22(1):30-8.
Bymaster FP, Nelson DL, DeLapp NW, Falcone JF, Eckols K, Truex LL, et al. Antagonism by olanzapine of dopamine D1, serotonin2, muscarinic, histamine H1 and alpha 1-adrenergic receptors in vitro. Schizophr Res 1999;37(1):107-22.
Zhang W, Bymaster FP. The in vivo effects of olanzapine and other antipsychotic agents on receptor occupancy and antagonism of dopamine D1, D2, D3, 5HT2A and muscarinic receptors. Psychopharmacology (Berl) 1999;141(3):267-78.
Bymaster FP, Falcone JF, Bauzon D, Kennedy JS, Schenck K, DeLapp NW, et al. Potent antagonism of 5-HT(3) and 5-HT(6) receptors by olanzapine. Eur J Pharmacol 2001;430(2-3):341-9.
DubÃ© S, Tollefson GD, Thase ME, Briggs SD, Van Campen LE, Case M, et al. Onset of antidepressant effect of olanzapine and olanzapine/fluoxetine combination in bipolar depression. Bipolar Disord 2007;9(6):618-27.
Ghaemi SN, Cherry EL, Katzow JA, Goodwin FK. Does olanzapine have antidepressant properties? A retrospective preliminary study. Bipolar Disord 2000;2:196-9.
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.
Navari RM, Einhorn LH, Loehrer PJ Sr, Passik SD, Vinson J, McClean J, et al. A phase II trial of olanzapine, dexamethasone, and palonosetron for the prevention of chemotherapy-induced nausea and vomiting: A Hoosier oncology group study. Support Care Cancer 2007;15:1285-91.
Mizukami N, Yamauchi M, Koike K, Watanabe A, Ichihara K, Masumori N, et al. Olanzapine for the prevention of chemotherapy-induced nausea and vomiting in patients receiving highly or moderately emetogenic chemotherapy: A randomized, double-blind, placebo-controlled study. J Pain Symptom Manage 2014;47(3):542-50.
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(5):188-95.
Wang X, Wang L. Effectiveness of olanzapine in prevention of chemotherapy induced nausea and vomiting. Clin J Clin 2012;6:7406-7.
Lu YL, Liu W, Du YJ. Antiemetic effect of low dose olanzapine in solid tumor chemotherapy. Clin J Cancer Prev Treat 2013;20:544-54.
Noviyani R, Indrayathi PA, Budiana IN, Suwiyoga K, Tunas K. Assessment of life quality in patients with stage IIB-IIIB squamous cell cervical cancer receiving paclitaxel cisplatin chemotherapy regimen by eortc QLQ-C30 questionnaire in sanglah hospital denpasar. Int J Pharm Pharm Sci 2017;9:222-6.
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European organization for research and treatment of cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993;85(5):365-76.
Michelson H, Bolund C, Nilsson B, Brandberg Y. Health-related quality of life measured by the EORTC QLQ-C30-reference values from a large sample of Swedish population. Acta Oncol 2000;39(4):477-84.
Available from: http://www.groups.eortc.be/qol. [Last accessed on 2012 Jun 11].
Common Terminology Criteria for Adverse Events (CTCAE). Version 4.0.National Institutes of Health National Cancer Institute; 2009. Available from: http://www.eortc.be//doc//CTCAE_4.03_2010-06-14_QuickReference_5x7. [Last accessed on 2013 May 16].
Hesketh PJ. Comparative review of 5-HT3 receptor antagonists in the treatment of acute chemotherapy-induced nausea and vomiting. Cancer Invest 2000;18(52):163-73.
YalÃ§in S, Tekuzman G, Baltali E, Ozisik Y, Barista I. Serotonin receptor antagonists in prophylaxis of acute and delayed emesis induced by moderately emetogenic, single-day chemotherapy: A randomized study. Am J Clin Oncol 1999;22(1):94-6.
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(2):134-42.
Available from: https://www.uptodate.com/contents/olanzapine-drug-information?source=search_result&search=olanzapine%20adult&selectedTitle=1~130. [Last accessed on 2017 Jan 24].
Babu G, Saldanha SC, Chinnagiriyappa LK, Jacob LA, Mallekavu SB, Dasappa L, et al. The efficacy, safety, and cost benefit of olanzapine versus aprepitant in highly emetogenic chemotherapy: A pilot study from South India. Chemother Res Pract 2016;2016:3439707.
Sekine I, Segawa Y, Kubota K, Saeki T. Risk factors of chemotherapy-induced nausea and vomiting: Index for personalized antiemetic prophylaxis. Cancer Sci 2013;104(6):711-7.
Schwartzberg LS. Chemotherapy-induced nausea and vomiting: Clinician and patient perspectives. J Support Oncol 2007;5 2 Suppl 1:5-12.
Basch E, Prestrud AA, Hesketh PJ, Kris MG, Feyer PC, Somerfield MR, et al. Antiemetics: American society of clinical oncology clinical practice guideline update. J Clin Oncol 2011;29(31):4189-98.
Warr DG, Street JC, Carides AD. Evaluation of risk factors predictive of nausea and vomiting with current standard-of-care antiemetic treatment: Analysis of phase 3 trial of aprepitant in patients receiving adriamycin-cyclophosphamide-based chemotherapy. Support Care Cancer 2011;19:807-13.
Seaburg HL, McLendon BM, Doraiswamy PM. Olanzapine-associated severe hyperglycemia, ketonuria, and acidosis: Case report and review of literature. Pharmacotherapy 2001;21(1):1448-54.
Allison DB, Casey DE. Antipsychotic-induced weight gain: A review of the literature. J Clin Psychiatry 2001;62 Suppl 7:22-31.
Hale AS. Olanzapine. Br J Hosp Med 1997;58:442-5.
FDA. Olanzapine: Drug Safety Communication-FDA Warns about Rare But Serious Skin Reactions. Available from: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm500123.htm. [Last accessed on 2017 Jan 18].
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