Olanzapine Effective for Chronic Nausea, Vomiting in Patients With Advanced Cancer

In a double-blind study, olanzapine was shown to be effective for controlling nausea and emesis in patients with advanced cancer who had persistent nausea/vomiting not associated with chemotherapy or radiotherapy (JAMA Oncol. 2020;6[6]:1-5).

“Nausea and vomiting, unrelated to chemotherapy, can be substantial symptoms in patients with advanced cancer,” wrote Rudolph M. Navari, MD, Comprehensive Cancer Center, University of Alabama at Birmingham, and colleagues, who sought to assess the utility of olanzapine for treating chronic nausea/vomiting not related to chemotherapy in patients with advanced cancer.

A total of 30 outpatients (mean age, 63 years) with advanced cancer who had persistent nausea/vomiting without having received chemotherapy or radiotherapy in the past 14 days were enrolled in the placebo-controlled study.

Between July 2017 and April 2019, patients in the study were randomized to receive olanzapine 5 mg (n = 15) or a placebo (n = 15) daily for 7 days.

The main end point of the study was a change in nausea numeric rating scores from baseline to the last day of treatment, measured using patient-reported outcomes. Dr Navari et al conducted their analysis in 2019.

All patients had median nausea scores at baseline that were 9 out of 10; 1 week into the study, the median nausea scores were 9 out of 10 in the placebo arm versus 1 out of 10 in the controlled arm.

According to the findings, the primary 2-sided end point P value was <.001. Similarly, patients given olanzapine reported less emesis, reduced use of other antiemetic drugs, better appetite, less sedation, less fatigue, and better well-being.

There was 1 patients in the placebo arm who stopped therapy because of a lack of perceived benefit. There were no reports of excess sedation or any other adverse events in the olanzapine arm.

“Olanzapine, at 5 mg/d, appeared to be effective in controlling nausea and emesis and in improving other symptoms and quality-of-life parameters in the study population,” Dr Navari and colleagues concluded.—Hina M. Porcelli