The use of olanzapine compared to aprepitant as antiemetic for prevention of chemotherapy induced nausea and vomiting in highly emetogenic chemotherapy - A randomized trial

Background: Chemotherapy induced nausea and vomiting (CINV) is still a major problem in highly emetogenic chemotherapy protocols. Current guidelines recommends use of Neurokinin 1 inhibitors(aprepitant), 5HT3 antagonist and dexamethasone for prevention of CINV. Use of olanzapine has been shown to be effective and safe as well as cheap alternative to standard antiemetic protocol. The purpose of this study was to compare effect of Olanzapine on nausea and vomiting when compared to standard antiemetic protocol. Methods and Materials: Chemotherapy naive fifty patients who were planned to receive highly emetogenic chemotherapy protocol (CDDP >60 mg/m2, Adriamycin >60 mg/m2, Epirubicin >90 mg/m2 or Ifosfamide >2 mg/m2) were enrolled. 25 patients were randomly grouped on each arm. In Arm A, Tab Aprepitant 180 mg, Inj Granisetron 1 mg IV and Dexamethasone 12 mg on D1, Tab Aprepitant 80 mg D2 and D3, Dexamethasone 8 mg PO OD D2, D3 and D4 was given. In Arm B, patients received Tab Olanzapine 10 mg, Inj Granisetron 1 mg IV and Dexamethasone 12 mg was given on D1 and Tab Olanzapine 10 mg PO and Tab Dexamethasone 8 mg PO OD D2, D3 and D4 was given. Results: Complete response (no emesis, no rescue) was 88% for acute period (24 hrs post chemotherapy) and 76% for delayed period (days 2-5 post chemotherapy) for 25 patients in Arm A (Aprepitant-containing regimen). Complete response was 84% for acute period and 72% for delayed period for 25 patients in Arm B (Olanzapine-containing regimen). There were no grade 3 and 4 toxicities. No patients who had complete response on cycle 1 developed nausea and vomiting on subsequent cycles. Olanzapine-containing regimen was comparable with aprepitant-containing regimen in control of CINV. Conclusion: In this study, Olanzapine when combined with dexamethasone and granisetron was very effective at controlling acute and delayed CINV in patients receiving highly emetogenic chemotherapy. Olanzapine can be safe, effective and cheaper alternative for controlling CINV in patient receiving highly emetogenic chemotherapy.