Olanzapine Helps Manage Nausea and Vomiting in Patients with Advanced Cancer

May 16, 2020

This trial found that olanzapine may help patients with advanced cancer successfully manage nausea and vomiting unrelated to chemotherapy.

A randomized pilot trial published in JAMA Oncology found that olanzapine (Zyprexa) may help patients with advanced cancer successfully manage nausea and vomiting unrelated to chemotherapy and is relatively well tolerated.1

Notably, no other drug studied in this environment has been reported to decrease nausea or vomiting more than was observed in this study. 

"Olanzapine given at 5 milligrams per day for seven days markedly improved patient quality of life with no side effects,” Rudolph Navari, MD, from the University of Alabama at Birmingham, said in a press release.2 "And as a generic drug, it's also relatively affordable, with a one-month supply often costing anywhere from $10 to $15.”

The primary objective of the trial was to estimate the effect of olanzapine vs placebo on chronic nausea and vomiting. Moreover, the selected primary endpoint was the change in nausea scores from baseline to the last treatment day using a numeric rating score. 

Eligible trial participants were outpatients with advanced cancer who had persistent nausea or vomiting without having had chemotherapy or radiotherapy in the prior 14 days. Patients received 5 mg of olanzapine or a placebo, orally, daily for 7 days. Overall, a total of 30 patients were enrolled, including 16 women and 14 men with a mean age of 63 years (range, 39-79). 

Baseline median nausea scores, for all patients, were 9 out of 10 (range, 8-10). After 1 day and 1 week, the median nausea scores in the placebo arm were 9 out of 10 (range, 8-10) on both days, compared with the olanzapine arm scores of 2 out of 10 (range, 2-3) after day 1 and 1 out of 10 (range, 0-3) after 1 week. 

Following 1 week of treatment, the reduction in nausea scores in the olanzapine arm was 8 points (95% CI, 7-8) higher than that seen in the placebo arm. Moreover, the primary 2-sided endpoint P value was < 0.001.

"It's well-appreciated by most people that patients receiving cancer chemotherapy suffer from nausea and vomiting," Charles Loprinzi, MD, a medical oncologist at Mayo Clinic, said in a press release. "However, it's less well-appreciated that patients with advanced cancer also have significant problems with nausea and vomiting that are unrelated to chemotherapy."

Subsequently, patients in the olanzapine arm also reported less emesis, less use of other antiemetic drugs, better appetite, less sedation, less fatigue, and better well-being. Even further, 1 patient on the placebo stopped treatment early owing to lack of perceived benefit. Additionally, no patients receiving olanzapine reported excess sedation or any other adverse event.

The researchers noted that the small sample size of the trial was a clear study limitation; therefore, further research regarding the utility of olanzapine for controlling nausea and vomiting in patients with advanced cancer is warranted.

"Current guidelines for the management of nausea and vomiting in patients with advanced cancer have not specifically indicated that one drug looks substantially better than a variety of other drugs," Loprinzi explained. "However, we believe the present results may be viewed as a best practice for treating nausea and vomiting in patients with advanced cancer-associated nausea and vomiting.”

References:

1. Navari RM, Pywell CM, Le-Rademacher JG, White P, Dodge AB, Albany C, Loprinzi CL. Olanzapine for the Treatment of Advanced Cancer-Related Chronic Nausea and/or Vomiting. JAMA Oncology. doi:10.1001/jamaoncol.2020.1052.

2. Olanzapine may help control nausea, vomiting in patients with advanced cancer [news release]. Rochester, Minnesota. Published May 7, 2020. newswise.com/articles/olanzapine-may-help-control-nausea-vomiting-in-patients-with-advanced-cancer?sc=mwhr&xy=10021790. Accessed May 12, 2020.