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Olanzapine controls breakthrough chemotherapy-induced nausea and vomiting


“This is the first time that breakthrough (chemotherapy-induced nausea and vomiting) has been studied in a systematic way,” said Rudolph M. Navari, M.D., Ph.D., lead author of the study and professor of medicine, associate dean of Indiana University School of Medicine-South Bend at the University of Notre Dame and clinical director of the Harper Cancer Research Institute.  “This study suggests that olanzapine will be very useful in these patients who feel very sick and sometimes come to the clinic, hospital or emergency room. As a result, patients will feel better.”

Dr. Navari is presenting his findings next month at the annual conferences of the American Society of Clinical Oncology and the Multinational Association of Supportive Care in Cancer 2012 Annual International Symposium.

 Thirty to 50 percent of cancer patients who are receiving highly emetogenic treatments (causing nausea or vomiting) experience “breakthrough” side effects two to four days after chemotherapy. Besides affecting a patient’s quality of life, breakthrough chemotherapy-induced nausea and vomiting can necessitate reductions in their chemotherapy doses, possibly limiting the effectiveness of treatment.

Although there has been little research about breakthrough chemotherapy-induced nausea and vomiting, these symptoms often are treated with metoclopramide. The double-blind, randomized controlled trial compared olanzapine to metoclopramide. Patients who received olanzapine did significantly better than the patients who received metoclopramide.

The study monitored 80 patients from north central Indiana who experienced breakthrough chemotherapy-induced nausea and vomiting; half were given olanzapine, and half received metoclopramide. Olanzapine provided significantly more relief for both nausea and vomiting. Now available in generic form at a cost of 45 cents per dose, olanzapine has the additional advantage of being inexpensive. The study was supported by the Reich Family Endowment for the Care of the Whole Patient.

While olanzapine, approved by FDA for treatment of psychosis, is known to cause a variety of side effects when taken daily for six months or longer, it is administered to breakthrough chemotherapy-induced nausea and vomiting patients for no longer than three days. The short-term use in this study did not lead to any significant toxicities.

Dr. Navari has performed a number of studies that have identified olanzapine as an effective treatment for minimizing nausea and vomiting for various points during chemotherapy as well as for reversing chemotherapy-induced anorexia.

“While we are far from preventing all cancers, I believe that we are close to eliminating much of the suffering associated with chemotherapeutics,” Dr. Navari said.