Chiu, L., Chiu, N., Chow, R., Zhang, L., Pasetka, M., Stinson, J., . . . DeAngelis, C. (2016). Olanzapine for the prophylaxis and rescue of chemotherapy induced nausea and vomiting (CINV): A retrospective study. Annals of Palliative Medicine, 5, 172–178.

DOI Link

Study Purpose

Evaluate the safety and efficacy of olanzapine for prevention and rescue of CINV

Intervention Characteristics/Basic Study Process

Medical records of adult patients who received one or more doses of olanzapine for prophylaxis of CINV or treatment of breakthrough CINV were reviewed. Routinely patients are phoned by a pharmacist or research assistant 72 hours after each chemotherapy cycle and an assessment of CINV is documented in the electronic record. Patients were on various chemotherapy and antiemetic regimens.

Sample Characteristics

  • N: 170   
  • AGE: Median = 51 years (range = 20-85)
  • MALES: 16.5%  
  • FEMALES: 83.5%
  • CURRENT TREATMENT: Chemotherapy
  • KEY DISEASE CHARACTERISTICS: Various tumor types–breast was most common (57%)

Setting

  • SITE: Single site   
  • SETTING TYPE: Outpatient    
  • LOCATION: Canada

Study Design

Retrospective descriptive

Results

Olanzapine was used for breakthrough in 154 patients over 193 treatment cycles. 88.1% of patients reported that it improved nausea, and 21.8% reported it improved vomiting. Twenty patients had been given olanzapine for prophylaxis. Among these 100% reported it improved nausea, and 35% said it improved vomiting. Analysis showed that olanzapine effects were not related to cycle, emetogenicity of the chemotherapy, or antiemetic regimen used. Side effects observed were sedation with continuation of olanzapine (29.5%).

Conclusions

Olanzapine was shown to have been effective as a rescue medication for CINV and may be effective for CINV prophylaxis.

Limitations

  • Baseline sample/group differences of import         
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Measurement/methods not well described
  • Measurement validity/reliability questionable
  • Other limitations/explanation: No subgroup analysis based on emetogenicity of chemotherapy and antiemetic regimen–these factors could confound results seen. No standard approach to measurement or reporting of CINV symptoms.

Nursing Implications

Olanzapine can be effective as a rescue medication for CINV and as part of a CINV prophylaxis regimen.