Flank, J., Thackray, J., Nielson, D., August, A., Schechter, T., Alexander, S., . . . Dupuis, L.L. (2015). Olanzapine for treatment and prevention of acute chemotherapy-induced vomiting in children: A retrospective, multi-center review. Pediatric Blood and Cancer, 62, 496–501. 

To explore the efficacy and safety of olanzapine in children aged 3–17 years for chemotherapy-induced vomiting (CIV) control

This was a retrospective review of 60 children (158 chemotherapy blocks) who received olanzapine for acute CIV control at institutions in Canada and the United States over a 30-month period. All CIV data were abstracted from the childrens' health records. 

• N = 60  
• MEAN AGE = 13.2 years (range = 3–17 years)
• MALES: 29 (48%), FEMALES: 31 (52%)
• KEY DISEASE CHARACTERISTICS: All children had acute CIV, but diagnoses varied and included osteosarcoma, neuroblastoma, brain tumors, acute lymphoblastic leukemia, rhabdomyosarcoma, and other sarcomas. 
• OTHER KEY SAMPLE CHARACTERISTICS: The median time from cancer diagnosis till the first block of chemotherapy where olanzapine was given was 3.2 months with a range of 0.1–90 months. Children who received oral olanzapine for CIV control and those who received it during the acute phase of the chemotherapy block were eligible. 

• SITE: Multi-site    
• SETTING TYPE: Multiple settings    
• LOCATION: Children’s Medical Center in Dallas, TX; the Hospital for Sick Children at the University of Toronto, Ontario; and the Memorial Sloan Kettering Cancer Center and Children’s Mercy Hospitals and Clinics in Kansas City, MO

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Pediatrics

Retrospective chart audit

• The primary outcome was complete response (no CIV).
• Other variables collected from the retrospective audit included age, weight, height, sex, diagnosis, date of diagnosis, antineoplastic and antiemetic medications received, reason for olanzapine, dose and duration, number of vomiting episodes on each day of chemotherapy, liver function tests, reports of drowsiness and dizziness, and other adverse effects from olanzapine.

Sixty children were given olanzapine in 128 blocks of chemotherapy on the first day of chemotherapy (usually highly emetogenic chemotherapy). Children in 125 of the 128 blocks received ondansetron or granisetron, dexamethasone (55%), or aprepitant (18%). Acute-phase CIV control was obtained in 83 (65%) blocks. There was no association between complete response and the olanzapine dose. The most commonly reported side effects were sedation (7%) and increased plasma transaminase concentrations (5%).

Olanzapine may be a useful option for CIV control in pediatric patients. However, the findings from this study were inconclusive regarding clinical efficacy.

• Small sample (< 30)
• Small sample (< 100)
• Other limitations/explanation: The age range was very wide, from 3-year-olds to young adults aged 17 years. They may have responded very differently to medications. The analysis makes it difficult to determine the impact of olanzapine because the other antiemetics that were used varied.

Nurses caring for children with acute CIV should know that olanzapine in a well-monitored situation may be a safe alternative. However, its efficacy was unclear in this study. A prospective study to determine the role of olanzapine alone and in combination with other antiemetics for varied levels of emetogenicity is warranted.