Olanzapine versus Aprepitant as Antiemetic in Highly Emetogenic Chemotherapy - A Randomized Clinical Trial

Abstract

Introduction: Chemotherapy induced nausea and vomiting is still a major problem in highly emetogenic chemotherapy protocols. Current guidelines use neurokinin 1 inhibitors, 5-hydroxytryptamine 3 receptor antagonist (5HT3) antagonist and dexamethasone for its prevention. Use of olanzapine has been shown to be effective, safe as and 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: Chemotherapy naive fifty patients receiving highly emetogenic chemotherapy were enrolled. 25 patients were randomly grouped on each arm. In arm A, tab aprepitant 125 mg, inj granisetron 1mg and tab dexamethasone 12 mg on day 1, tab aprepitant 80mg day 2 and day 3, tab dexamethasone 8mg day 2, day 3 and day 4 was given. In Arm B, patients received tab olanzapine 10mg, inj granisetron 1mg and tab dexamethasone 12 mg was given on day 1 and tab olanzapine 10mg PO and tab dexamethasone 8mg day 2, day 3 and day 4 was given. Results: Complete response was 88 % for acute period (24 hours post chemotherapy) and 76% for delayed period (2-5 days post chemotherapy) in Arm A and 84 % for acute period and 72% for delayed period in Arm B, there were no grade 3 and 4 toxicities. Olanzapine containing regimen was comparable with aprepitant containing regimen in control of chemotherapy induced nausea and vomiting. Conclusion: Olanzapine when combined with dexamethasone and granisetron is very effective at controlling nausea and vomiting in patients receiving highly emetogenic chemotherapy. Olanzapine can be a safe, effective and cheaper alternative to aprepitant.