How the antiemetic olanzapine performs for moderately emetogenic chemo

Adding olanzapine significantly improved complete response rates—as well as nausea and vomiting prevention rates—in an RCT of patients receiving moderately emetogenic chemotherapy for malignant solid tumors.

• This multicenter, open-label, phase 3 trial included 560 adults (64% male; median age, 51 years old) who were receiving oxaliplatin-, carboplatin-, or irinotecan-based chemotherapy for solid malignant tumors, at 3 centers in India from 2019 to 2023.
• Patients were randomized 1:1 to dexamethasone, aprepitant, and palonosetron—with or without olanzapine 10 mg po QHS on days 1-3 of chemotherapy.
• The primary endpoint was complete response, defined as the proportion of patients without vomiting, significant nausea (on visual analog scale), or nausea rescue medication use.
• Complete response rate was better with olanzapine than without it (91% vs. 82%), as was nausea control (96% vs. 87%), and rescue medication use (4% vs. 10%).
• More patients receiving olanzapine reported grade 1 somnolence than controls (10% vs. 0%).

Source:

Ostwal V, et al. (2024, August 1). JAMA Netw Open. Olanzapine as Antiemetic Prophylaxis in Moderately Emetogenic Chemotherapy: A Phase 3 Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/39106066/