Nausea and Vomiting (PDQ®): Supportive care - Health Professional Information [NCI] - Prevention of Acute / Delayed Nausea and Vomiting (Emesis)
Table 2. Comparison of Aprepitant and Standard Regimens continued...
Using the maximum tolerated dose of olanzapine in the phase I trial, a phase II trial was performed for the prevention of CINV in patients receiving their first course of either highly emetogenic or moderately emetogenic chemotherapy. Olanzapine was added to granisetron and dexamethasone prechemotherapy and to dexamethasone postchemotherapy. CR (no emesis, no rescue) was 100% for the acute period (24 hours postchemotherapy), 80% for the delayed period (days 2–5 postchemotherapy), and 80% for the overall period (0–120 hours postchemotherapy) in ten patients receiving highly emetogenic chemotherapy (cisplatin, ≥70 mg/m2). CR was also 100% for the acute period, 85% for the delayed period, and 85% for the overall period in 20 patients receiving moderately emetogenic chemotherapy (doxorubicin, ≥50 mg/m2). Nausea was very well controlled in the patients receiving highly emetogenic chemotherapy, with no patient having nausea (0 on a scale of 0–10, M. D. Anderson Symptom Inventory) in the acute or delayed periods. Nausea was also well controlled in patients receiving moderately emetogenic chemotherapy, with no nausea in 85% of patients in the acute period and in 65% of patients in the delayed and overall periods. There were no grade 3 or 4 toxicities. On the basis of these data, olanzapine appeared to be safe (sedation was the only dose-limiting toxicity) and effective in controlling acute and delayed CINV in patients receiving highly emetogenic and moderately emetogenic chemotherapy.[Level of evidence: II]
Subsequent studies have shown the effectiveness of olanzapine as an antiemetic. Olanzapine combined with a single dose of dexamethasone and a single dose of palonosetron was very effective in controlling acute and delayed CINV in patients receiving either moderately emetogenic chemotherapy or highly emetogenic chemotherapy. A large end study [Level of evidence: I] demonstrated that in patients receiving either highly emetogenic chemotherapy or moderately emetogenic chemotherapy, the addition of olanzapine to azasetron and dexamethasone improved the CR of delayed CINV.
Other Pharmacologic Agents
The antiemetic effect of ginger powder (Zingiber officinale) was explored in a double-blind, placebo-controlled, randomized trial among 32 children and young adults, aged 8 to 21 years, with newly diagnosed bone sarcomas. Cycles of chemotherapy were randomly assigned to ginger powder (1,000 to 2,000 mg per day) or placebo on days 1 to 3 of treatment. Patients were allowed to receive the standard antiemetic medications ondansetron and dexamethasone. The primary endpoint was the incidence and severity of acute N&V (occurring ≤24 hours from the start of chemotherapy) and delayed N&V (occurring >24 hours after completion of chemotherapy).
The authors reported a reduction in the incidence of moderate to severe acute nausea in the experimental arm (55.6 % of cycles), compared with the placebo arm (93.3% of cycles) (P = .003). Decreased incidence of moderate to severe vomiting was found in the experimental arm (33.3%), compared with the placebo arm (76.7%) (P = .002). The authors also reported decreased incidence of moderate to severe delayed nausea (P < .001) and vomiting (P = .022) in the experimental arm, compared with placebo. No adverse events were reported.