International Journal of Clinical Pharmacy

, Volume 40, Issue 5, pp 1265–1271 | Cite as

Olanzapine as antiemetic drug in oncology: a retrospective study in non-responders to standard antiemetic therapy

  • Florian SlimanoEmail author
  • Florence Netzer
  • Isabelle Borget
  • François Lemare
  • Benjamin Besse
Research Article


Background The role of olanzapine in the treatment of chemotherapy-induced nausea and vomiting (CINV) in addition to the antiemetic therapeutic combination with aprepitant, setrons, and corticosteroids has not been well defined. Objective To investigate the effectiveness of the addition of olanzapine to a standard triplet therapy for the prevention of CINV in patients who experienced CINV during their first chemotherapy course, despite receiving a well-managed prevention protocol. Setting One comprehensive cancer centre in France. Method In a retrospective study with comparator, patients with a high risk of emesis were assigned to two groups during two different 6-month periods, before and after the introduction of olanzapine in clinical practice, respectively. In the olanzapine group, the antiemetic protocol for the second course of chemotherapy was reinforced by the addition of olanzapine at 5 mg/day from day 1 to 5 in contrast with the control group. Main outcome measure The proportion of patients who experienced neither nausea nor emesis during the delayed phase (24–120 h). Results The 25 patients in each group exhibited comparable characteristics and emetic chemotherapy level. During the first course, no significant difference was observed. During the second course, nausea and vomiting were ameliorated in 12 patients in the olanzapine group and 4 patients in the control group (p < 0.05). Nausea (12 vs. 4, p < 0.05) and vomiting (18 vs. 11, p < 0.05) also significantly improved. In the OLZ group, no adverse event was linked to olanzapine use. Conclusion The addition of olanzapine was observed to effectively restore CINV prevention in patients who did not respond to standard antiemetic therapy.


Antiemetics Chemotherapy-induced nausea and vomiting France Olanzapine Secondary prophylaxis 



Mr. Vincent Blazy for the help in software data extraction.



Conflicts of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Bloechl-Daum B, Deuson RR, Mavros P, Hansen M, Herrstedt J. Delayed nausea and vomiting continue to reduce patients’ quality of life after highly and moderately emetogenic chemotherapy despite antiemetic treatment. J Clin Oncol. 2006;24(27):4472–8.CrossRefGoogle Scholar
  2. 2.
    Fernández-Ortega P, Caloto MT, Chirveches E, Marquilles R, Francisco JS, Quesada A, et al. Chemotherapy-induced nausea and vomiting in clinical practice: impact on patients’ quality of life. Support Care Cancer. 2012;20(12):3141–8.CrossRefGoogle Scholar
  3. 3.
    Sommariva S, Pongiglione B, Tarricone R. Impact of chemotherapy-induced nausea and vomiting on health-related quality of life and resource utilization: a systematic review. Crit Rev Oncol Hematol. 2016;99:13–36.CrossRefGoogle Scholar
  4. 4.
    Carlotto A, Hogsett VL, Maiorini EM, Razulis JG, Sonis ST. The economic burden of toxicities associated with cancer treatment: review of the literature and analysis of nausea and vomiting, diarrhoea, oral mucositis and fatigue. Pharmacoeconomics. 2013;31(9):753–66.CrossRefGoogle Scholar
  5. 5.
    Navari RM, Aapro M. Antiemetic prophylaxis for chemotherapy-induced nausea and vomiting. N Engl J Med. 2016;374(14):1356–67.CrossRefGoogle Scholar
  6. 6.
    Roila F, Molassiotis A, Herrstedt J, Aapro M, Gralla RJ, Bruera E, et al. 2016 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting and of nausea and vomiting in advanced cancer patients. Ann Oncol. 2016;27(suppl. 5):v119–33.CrossRefGoogle Scholar
  7. 7.
    Berger MJ, Ettinger DS, Aston J, Barbour S, Bergsbaken J, Bierman PJ, et al. Antiemesis, Version 2.2017. Featured updates to the NCCN guidelines. J Natl Compr Canc Netw. 2017;15:883–93.CrossRefGoogle Scholar
  8. 8.
    Hesketh PJ, Kris MG, Basch E, Bohlke K, Barbour SY, Clark-Snow RA, et al. Antiemetics: American society of clinical oncology clinical practice guideline update. J Clin Oncol. 2017;35(28):3240–61.CrossRefGoogle Scholar
  9. 9.
    de Wit R, Herrstedt J, Rapoport B, Carides AD, Carides G, Elmer M, et al. Addition of the oral NK1 antagonist aprepitant to standard antiemetics provides protection against nausea and vomiting during multiple cycles of cisplatin-based chemotherapy. J Clin Oncol. 2003;21(22):4105–11.CrossRefGoogle Scholar
  10. 10.
    Roscoe JA, Bushunow P, Morrow GR, Hickok JT, Kuebler PJ, Jacobs A, et al. Patient expectation is a strong predictor of severe nausea after chemotherapy: a University of Rochester Community Clinical Oncology Program study of patients with breast carcinoma. Cancer. 2004;101(11):2701–8.CrossRefGoogle Scholar
  11. 11.
    Bymaster FP, Calligaro DO, Falcone JF, Marsh RD, Moore NA, Tye NC, et al. Radioreceptor binding profile of the atypical antipsychotic olanzapine. Neuropsychopharmacology. 1996;14(2):87–96.CrossRefGoogle Scholar
  12. 12.
    Pirl WF, Roth AJ. Remission of chemotherapy-induced emesis with concurrent olanzapine treatment: a case report. Psychooncology. 2000;9(1):84–7.CrossRefGoogle Scholar
  13. 13.
    Passik SD, Kirsh KL, Theobald DE, Dickerson P, Trowbridge R, Gray D, et al. A retrospective chart review of the use of olanzapine for the prevention of delayed emesis in cancer patients. J Pain Symptom Manag. 2003;25(5):485–8.CrossRefGoogle Scholar
  14. 14.
    Passik SD, Navari RM, Jung S-H, Nagy C, Vinson J, Kirsh KL, et al. A phase I trial of olanzapine (Zyprexa) for the prevention of delayed emesis in cancer patients: a Hoosier Oncology Group study. Cancer Invest. 2004;22(3):383–8.CrossRefGoogle Scholar
  15. 15.
    Abe M, Hirashima Y, Kasamatsu Y, Kado N, Komeda S, Kuji S, et al. Efficacy and safety of olanzapine combined with aprepitant, palonosetron, and dexamethasone for preventing nausea and vomiting induced by cisplatin-based chemotherapy in gynecological cancer: KCOG-G1301 phase II trial. Support Care Cancer. 2016;24(2):675–82.CrossRefGoogle Scholar
  16. 16.
    Navari RM, Qin R, Ruddy KJ, Liu H, Powell SF, Bajaj M, et al. Olanzapine for the prevention of chemotherapy-induced nausea and vomiting. N Engl J Med. 2016;375(2):134–42.CrossRefGoogle Scholar
  17. 17.
    Navari RM, Nagy CK, Gray SE. The use of olanzapine versus metoclopramide for the treatment of breakthrough chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy. Support Care Cancer. 2013;21(6):1655–63.CrossRefGoogle Scholar
  18. 18.
    Hocking CM, Kichenadasse G. Olanzapine for chemotherapy-induced nausea and vomiting: a systematic review. Support Care Cancer. 2014;22(4):1143–51.CrossRefGoogle Scholar
  19. 19.
    Fonte C, Fatigoni S, Roila F. A review of olanzapine as an antiemetic in chemotherapy-induced nausea and vomiting and in palliative care patients. Crit Rev Oncol Hematol. 2015;95(2):214–21.CrossRefGoogle Scholar
  20. 20.
    Chelkeba L, Gidey K, Mamo A, Matso T, Yohannes B, Melaku T. Olanzapine for chemotherapy-induced nausea and vomiting: systematic review and meta-analysis. Pharm Pract. 2017;15(1):877.CrossRefGoogle Scholar
  21. 21.
    Chiu L, Chow R, Popovic M, Navari RM, Shumway NM, Chiu N, et al. Efficacy of olanzapine for the prophylaxis and rescure of chemotherapy-induced nausea and vomiting (CINV): a systematic review and meta-analysis. Support Care Cancer. 2016;24(5):2381–92.CrossRefGoogle Scholar
  22. 22.
    DeRemer DL, Clemmons AB, Orr J, Clark SM, Gandhi AS. Emerging role of olanzapine for prevention and treatment of chemotherapy-induced nausea and vomiting. Pharmacotherapy. 2016;36(2):218–29.CrossRefGoogle Scholar
  23. 23.
    Yoodee J, Permsuwan U, Nimworapan M. Efficacy and safety of olanzapine for the prevention of chemotherapy-inducec nausea and vomiting: a systematic review and meta-analysis. Crit Rev Oncol Hematol. 2017;112:113–25.CrossRefGoogle Scholar
  24. 24.
    Tan L, Liu J, Liu X, Chen J, Yan Z, Yang H, et al. Clinical research of Olanzapine for prevention of chemotherapy-induced nausea and vomiting. J Exp Clin Cancer Res. 2009;28:131.CrossRefGoogle Scholar
  25. 25.
    Liu J, Tan L, Zhang H, Li H, Liu X, Yan Z, et al. QoL evaluation of olanzapine for chemotherapy-induced nausea and vomiting comparing with 5-HT3 receptor antagonist. Eur J Cancer Care. 2015;24(3):436–43.CrossRefGoogle Scholar
  26. 26.
    Mizukami N, Yamauchi M, Koike K, Watanabe A, Ichihara K, Masumori N, et al. Olanzapine for the prevention of chemotherapy-induced nausea and vomiting in patients receiving highly or moderately emetogenic chemotherapy: a randomized, double-blind, placebo-controlled study. J Pain Symptom Manag. 2014;47(3):542–50.CrossRefGoogle Scholar
  27. 27.
    Yanai T, Iwasa S, Hashimoto H, Ohyanagi F, Takigushi T, Takedas K, et al. A double-blind randomized phase II dose-finding study of olanzapine 10 mg or 5 mg for the prophylaxis of emesis induced by highly emetogenic cisplatin-based chemotherapy. Int J Clin Oncol. 2018;23(2):382–8.CrossRefGoogle Scholar
  28. 28.
    Hernandez Torres C, Mazzarello S, Ng T, Dranitsaris G, Hutton B, Smith S, et al. Defining optimal control of chemotherapy-induced nausea and vomiting-based on patients’ experience. Support Care Cancer. 2015;23(11):3341–59.CrossRefGoogle Scholar
  29. 29.
    Hale AS. Olanzapine. Br J Hosp Med. 1997;58(9):442–5.PubMedGoogle Scholar
  30. 30.
    Allison DB, Casey DE. Antipsychotic-induced weight gain: a review of the literature. J Clin Psychiatry. 2001;62(Suppl 7):22–31.PubMedGoogle Scholar
  31. 31.
    Fountaine RJ, Taylor AE, Mancuso JP, Greenway FL, Byerley LO, Smith SR, et al. Increased food intake and energy expenditure following administration of olanzapine to healthy men. Obesity. 2010;18(8):1646–51.CrossRefGoogle Scholar
  32. 32.
    Navari RM, Gray SE, Kerr AC. Olanzapine versus aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a randomized phase III trial. J Support Oncol. 2011;9(5):188–95.CrossRefGoogle Scholar
  33. 33.
    Nightingale G, Hajjar E, Swartz K, Andrel-Sendecki J, Chapman A. Evaluation of a pharmacist-led medication assessment used to identify prevalence of and associations with polypharmacy and potentially inappropriate medication use among ambulatory senior adults with cancer. J Clin Oncol. 2015;33(13):1453–9.CrossRefGoogle Scholar
  34. 34.
    Gilmore JW, Peacock NW, Gu A, Szabo S, Rammage M, Sharpe J, et al. Antiemetic guideline consistency and incidence of chemotherapy-induced nausea and vomiting in US community oncology practice: INSPIRE study. J Oncol Pract. 2014;10(1):68–74.CrossRefGoogle Scholar
  35. 35.
    Encinosa W, Dadidoff AJ. Changes in antiemetic overuse to choosing wisely recommendations. JAMA Oncol. 2016;3(3):320–6.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Clinical PharmacyGustave Roussy Cancer CampusVillejuifFrance
  2. 2.Faculty of PharmacyReims UniversityReimsFrance
  3. 3.Department of Biostatistic and Epidemiology, Gustave Roussy Cancer Campus, and INSERM U 1018Paris-Sud, Paris-Saclay UniversityChâtenay-MalabryFrance
  4. 4.GRADESParis-Sud, Paris-Saclay UniversityChâtenay-MalabryFrance
  5. 5.Faculty of PharmacyParis Descartes UniversityParisFrance
  6. 6.Department of Medical OncologyGustave Roussy Cancer CampusVillejuifFrance
  7. 7.Faculty of MedicineParis-Sud, Paris-Saclay UniversityLe Kremlin-Bicêtre CedexFrance

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