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Notini G, Naldini MM, Sica L, Viale G, Rognone A, Zambelli S, Zucchinelli P, Piras M, Bosi C, Mariani M, Aldrighetti D, Bianchini G, Licata L. Management of Trastuzumab Deruxtecan-related nausea and vomiting in real-world practice. Front Oncol 2024; 14:1374547. [PMID: 38529378 PMCID: PMC10961432 DOI: 10.3389/fonc.2024.1374547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/23/2024] [Indexed: 03/27/2024] Open
Abstract
Background Nausea and vomiting are common side effects of Trastuzumab Deruxtecan (T-DXd), but guidelines for optimal management were not initially available. This retrospective single-center study aimed at evaluating the efficacy of two antiemetic regimens in patients receiving T-DXd. Methods Data from metastatic breast cancer patients receiving T-DXd were collected. Two groups were defined: patients treated with 5-HT3 receptor antagonists (RA) ± dexamethasone (5-HT3-group) and patients treated with a fixed oral combination of netupitant (NK1RA) and palonosetron ± dexamethasone (NK1 group). Physicians preferentially offered the NK1 regimen to patients at higher risk of nausea and vomiting based on internal recommendations. Only nausea and vomiting during cycles 1 and 2 were considered. Comparisons of nausea and vomiting by the antiemetic prophylaxis group were assessed using chi-square. Results A total of 53 patients were included in the analysis. At cycle 1, 72% and 28% of patients received the 5-HT3 and NK1 prophylaxis, respectively. Overall, 58% reported nausea, with no differences between groups (58% vs. 60%; p = 0.832), but with a trend for lower grade in the NK1 group (33.3% G1; 26.7% G2) compared to the 5-HT3 group (23.7% G1; 31.6% G2; 2.6% G3). Vomiting was reported by 21% and 0% of patients in the 5-HT3 and the NK1 group, respectively (p = 0.054). Among the 15 patients in the 5-HT3 group with nausea at cycle 1 who escalated to NK1 at cycle 2, nausea decreased from 100% to 53% (p = 0.022) and vomiting decreased from 47% to 13% (p = 0.046). Conclusions The NK1 regimen improved vomiting control at cycle 1 and, when introduced at cycle 2, significantly improved both nausea and vomiting. The biased NK1 selection for higher-risk patients may have dampened the differences between groups at cycle 1. These findings support enhanced control of T-DXd-related nausea and vomiting with NK1RA.
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Affiliation(s)
- Giulia Notini
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Maria Naldini
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Lorenzo Sica
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Giulia Viale
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessia Rognone
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Stefania Zambelli
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Patrizia Zucchinelli
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Marta Piras
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Carlo Bosi
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Mariani
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Daniela Aldrighetti
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Giampaolo Bianchini
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Luca Licata
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milan, Italy
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Liu F, Liao R, Cai J, Bu M, Xu N, Zhou J. Efficacy of press needle treatment in reducing chemotherapy-induced nausea, vomiting, and retching gastrointestinal cancer patients: A randomized controlled trial. Asia Pac J Oncol Nurs 2023; 10:100291. [PMID: 37766754 PMCID: PMC10520324 DOI: 10.1016/j.apjon.2023.100291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/01/2023] [Indexed: 09/29/2023] Open
Abstract
Objective Chemotherapy-induced nausea and vomiting (CINV) and retching often pose challenges in managing patients with gastrointestinal cancer. This randomized controlled trial sought to evaluate the effectiveness of press needle therapy in mitigating CINV and retching following chemotherapy. Methods Two hundred patients with gastrointestinal cancer undergoing folinic acid, fluorouracil, and oxaliplatin (FOLFOX) chemotherapy were randomly assigned to either the press needle group or the control group. The control group received 5-hydroxytryptamine-3 (5-HT3) antagonists and dexamethasone 30 min before chemotherapy, followed by dexamethasone on days 2 and 3 after chemotherapy. In contrast, the press needle group received press needle treatment 30 min prior to chemotherapy. The primary outcome was the Index of Nausea, Vomiting, and Retching (INVR), assessed at seven time points: before chemotherapy and at 12, 24, 36, 48, 60, and 72 h post-chemotherapy. Results All patients completed their respective treatments, and no significant adverse effects related to press needle treatment (such as skin allergies, acupoint infections, headaches, or dizziness) were reported. A two-way repeated-measures analysis of variance (ANOVA) revealed significant differences in INVR scores between the two groups (P < 0.05). Further analysis with a t-test indicated that INVR scores in the press needle treatment group were significantly lower than those in the control group at 12, 24, and 36 hours after chemotherapy (P < 0.05), with no significant difference observed thereafter. Conclusions Press needle treatment effectively alleviated nausea, vomiting, and retching in patients with gastrointestinal cancer undergoing chemotherapy. It represents a safe, efficient, and convenient complement to preventive treatment with 5-HT3 antagonists. Trial registration Chinese Clinical Trial Registry (No. ChiCTR1900024554).
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Affiliation(s)
- Fenyu Liu
- Nursing Department, Integrated Hospital of Traditional Chinse Medicine, Southern Medical University, Guangzhou, China
| | - Rongrong Liao
- Oncology Department, Integrated Hospital of Traditional Chinse Medicine, Southern Medical University, Guangzhou, China
| | - Jianhong Cai
- Oncology Department, Integrated Hospital of Traditional Chinse Medicine, Southern Medical University, Guangzhou, China
| | - Mengru Bu
- Nursing Department, Integrated Hospital of Traditional Chinse Medicine, Southern Medical University, Guangzhou, China
| | - Ningjun Xu
- Nursing Department, Integrated Hospital of Traditional Chinse Medicine, Southern Medical University, Guangzhou, China
| | - Jin Zhou
- Nursing Department, Integrated Hospital of Traditional Chinse Medicine, Southern Medical University, Guangzhou, China
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Nakagawa N, Suzuki M. Efficacy of Olanzapine for Symptom Relief in Cancer Patients. J Pain Palliat Care Pharmacother 2022; 36:216-222. [PMID: 36250742 DOI: 10.1080/15360288.2022.2126059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Olanzapine is an atypical antipsychotic and is widely used for prophylaxis of chemotherapy-induced nausea and vomiting in cancer patients. Previous studies have suggested its potential efficacy for the relief of various symptoms in cancer patients, especially gastrointestinal and psychiatric symptoms. We retrospectively reviewed the prescription of olanzapine to cancer patients at our hospital. Between 2008 and 2020, olanzapine was prescribed to 41 patients for relief of symptoms associated with cancer other than prophylaxis of chemotherapy-induced nausea and vomiting. Of those patients, symptom relief was seen in 53.7%. Notably, olanzapine was effective in 13 of 14 patients with chemotherapy-induced nausea and vomiting refractory to guideline-recommended prophylaxis. Of 16 patients in whom this symptom was not relieved by olanzapine, 13 (81.3%) continued taking olanzapine even after it was judged ineffective. No treatment-related adverse events were seen in this study. Our observation implies good efficacy of olanzapine for refractory chemotherapy-induced nausea and vomiting and a tendency to continue olanzapine even in those for whom it was ineffective.
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Affiliation(s)
- Natsuki Nakagawa
- Department of Respiratory Medicine, Kanto Central Hospital, Tokyo, Japan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Kanto Central Hospital, Tokyo, Japan
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Olanzapine for the Prevention and Treatment of Chemotherapy-Induced Nausea and Vomiting: A Review to Identify the Best Way to Administer the Drug. Curr Oncol 2022; 29:8235-8243. [PMID: 36354710 PMCID: PMC9689588 DOI: 10.3390/curroncol29110650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
Common treatment methods for malignant tumors include surgery, chemotherapy, radiotherapy, immunotherapy, targeted therapy, etc., among which chemotherapy plays an important role. However, chemotherapy brings corresponding side effects while killing tumor cells, and nausea and vomiting are the most common adverse reactions induced by chemotherapy. It not only affects the patient's appetite, resulting in malnutrition and electrolyte disturbances, but also reduces the patient's compliance with treatment, which further aggravates the disease. Thus, it is important to quickly prevent and cure nausea and vomiting induced by chemotherapy (CINV). In addition, with the continuous development of medicine, more and more antiemetic drugs have been developed. At present, the most common antiemetic agents for chemotherapy-induced nausea and vomiting are NK-1R antagonists, 5-HT3R antagonists, and dexamethasone. Surprisingly, olanzapine, often used as a psychotropic drug, has been found to be an effective antiemetic and is similar to other regimens on the safety of medicine. However, although there are numerous studies on the antiemetic effects of olanzapine, its comprehensive application remains unclear. Therefore, this review will elaborate the antiemetic effect of olanzapine in terms of the antiemetic mechanism and the safety, economic cost, dose, administration time, and drug delivery aspects.
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Antiemetic Strategies in Patients Who Undergo Hematopoietic Stem Cell Transplantation. Clin Hematol Int 2022; 4:89-98. [PMID: 36131129 PMCID: PMC9492824 DOI: 10.1007/s44228-022-00012-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is an integral part of the treatment strategy in patients with a hematological disorder. Chemotherapy-induced nausea and vomiting (CINV) is still an issue in patients who undergo HSCT. While several guidelines for the antiemetic therapy against CINV have been published, there is no detailed information about appropriate antiemetic drugs for each conditioning regimen in HSCT. Various studies reported that the triplet of 5-HT3RA, NK1RA, and dexamethasone appears useful in HSCT. However, each antiemetic has unique adverse effects or interactions with specific drugs. Here, we review the literature relating to clinical trials on the prevention of CINV, and summarize the information to clarify the benefit of antiemetic regimens.
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Watanabe D, Iihara H, Fujii H, Makiyama A, Nishida S, Suzuki A. One-Day Versus Three-Day Dexamethasone with NK1RA for Patients Receiving Carboplatin and Moderate Emetogenic Chemotherapy: A Network Meta-analysis. Oncologist 2022; 27:e524-e532. [PMID: 35427418 PMCID: PMC9177112 DOI: 10.1093/oncolo/oyac060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/24/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The dexamethasone (DEX)-sparing strategy, which limits administration of DEX to day one, is reportedly non-inferior to conventional antiemetic regimens comprising multiple-day DEX. However, the usefulness of the DEX-sparing strategy in triplet antiemetic prophylaxis (neurokinin-1 receptor antagonist [NK1RA] + serotonin receptor antagonist [5HT3RA] + DEX) for carboplatin and moderate emetogenic chemotherapy (MEC) has not been clarified. PATIENTS AND METHODS We systematically reviewed randomized controlled trials that examined the efficacy of antiemetics for preventing chemotherapy-induced nausea and vomiting associated with carboplatin and MEC. We conducted a network meta-analysis to compare the antiemesis efficacy of three-day DEX with NK1RA (3-DEX + NK1RA) and one-day DEX with NK1RA (1-DEX + NK1RA). The primary outcome was complete response during the delayed phase (CR-DP). The secondary outcome was no nausea during the delayed phase (NN-DP). RESULTS Seventeen trials involving 4534 patients were included. The proportion who experienced CR-DP was 82.5% (95% credible interval [CI], 73.9-88.6) and 73.5% (95% CI, 62.8-80.9) among those who received 3-DEX + NK1RA and 1-DEX + NK1RA, respectively. There was no significant difference between the two regimens. However, 3-DEX + NK1RA tended to be superior to 1-DEX + NK1RA, with an absolute risk difference of 9.0% (95% CI, -2.3 to 21.1) in CR-DP and 24.7% (95% CI: -14.9 to 54.6) in NN-DP. 3-DEX + NK1RA also tended to be superior to 1-DEX + NK1RA in patients who received carboplatin-based chemotherapy, for whom the absolute risk difference was 12.3% (95% CI, -3.2 to 30.7). CONCLUSIONS Care is needed when administering the DEX-sparing strategy in combination with NK1RA to patients receiving carboplatin and non-carboplatin MEC.
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Affiliation(s)
- Daichi Watanabe
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | | | - Hironori Fujii
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | | | - Shohei Nishida
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Akio Suzuki
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
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Abstract
Among the side effects of anticancer treatment, chemotherapy-induced nausea and vomiting (CINV) is one of the most feared given its high prevalence, affecting up to 40% of patients. It can impair patient’s quality of life and provoke low adherence to cancer treatment or chemotherapy dose reductions that can comprise treatment efficacy. Suffering CINV depends on factors related to the intrinsic emetogenicity of antineoplastic drugs and on patient characteristics. CINV can appear at different times regarding the administration of antitumor treatment and the variability of risk according to the different antitumor regimens has, as a consequence, the need for a different and adapted antiemetic treatment prophylaxis to achieve the desired objective of complete protection of the patient in the acute phase, in the late phase and in the global phase of emesis. As a basis for the recommendations, the level of emetogenicity of anticancer treatment is considered and they are classified as high, moderate, low and minimal emetogenicity and these recommendations are based on the use of antiemetic drugs with a high therapeutic index: anti 5-HT, anti-NK and steroids. Despite having highly effective treatments, clinical reality shows that they are not applied enough, so evidence-based recommendations are needed to show the best options and help in decision-making. To cover all the antiemetic prophylaxis options, we have also included recommendations for oral treatments, multiday regimens and radiation-induced emesis prevention.
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Olanzapine 5 mg vs 10 mg for the prophylaxis of chemotherapy-induced nausea and vomiting: a network meta-analysis. Support Care Cancer 2021; 30:1015-1018. [PMID: 34613472 DOI: 10.1007/s00520-021-06606-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zhou JG, Huang L, Jin SH, Xu C, Frey B, Ma H, Gaipl US. Olanzapine combined with 5-hydroxytryptamine type 3 receptor antagonist (5-HT3 RA) plus dexamethasone for prevention and treatment of chemotherapy-induced nausea and vomiting in high and moderate emetogenic chemotherapy: a systematic review and meta-analysis of randomised controlled trials. ESMO Open 2021; 5:S2059-7029(20)30018-1. [PMID: 32079622 PMCID: PMC7046384 DOI: 10.1136/esmoopen-2019-000621] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 12/03/2019] [Accepted: 12/29/2019] [Indexed: 01/30/2023] Open
Abstract
We performed a pooled analysis to evaluate the efficacy and adverse events (AEs) of olanzapine combined with dexamethasone plus 5-hydroxytryptamine type 3 receptor antagonist (5-HT3 RA) compared with 5-HT3 RA plus dexamethasone for the prevention and treatment of chemotherapy-induced nausea and vomiting (CINV) in high and moderate emetogenic chemotherapy based on randomised controlled trials (RCTs). PubMed, EMBASE, Web of Science, the Cochrane Library, China Biomedical Literature database (CBM), WanFang Database, China National Knowledge Infrastructure (CNKI), and Chinese Science and Technology Periodical Database (VIP) (from their inception to April 2019) were searched to capture relevant articles. Relative risk with 95% confidence intervals for CINV and AEs were all extracted or calculated. Eleven studies with 1107 cancer patients were involved in this review. The pooled RR of delayed CINV (RR 0.50, 95% CI 0.38 to 0.66; p<0.01) were significantly decreased in the olanzapine group. The occurrence of insomnia was also statistically decreased, as was the rate of acute CINV (RR 0.60, 95% CI 0.48 to 0.75; p<0.01). However, only the percentages of CINV III and CINV IV were significantly decreased in the acute and delayed phases. Subgroup analysis demonstrated that the efficacy was not statistically significantly different between 5 mg and 10 mg olanzapine. Olanzapine significantly decreased the occurrence of CINV III and IV and insomnia in high and moderately emetogenic chemotherapy. Compared with 10 mg per day, 5 mg oral olanzapine may be more appropriate for patients with cancer.
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Affiliation(s)
- Jian-Guo Zhou
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Department of Radiation Oncology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Lang Huang
- Department of Oncology, Guangyuan Central Hospital, Guangyuan, China
| | - Su-Han Jin
- Department of Orthodontics, Affiliated Stomatological Hospital of Zunyi Medical University, Zunyi, China
| | - Cheng Xu
- Department of Oncology, Guangyuan Central Hospital, Guangyuan, China
| | - Benjamin Frey
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Hu Ma
- Department of Oncology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Udo S Gaipl
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Erlangen, Germany
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Cost-effectiveness analysis of olanzapine-containing antiemetic therapy for the prophylaxis of chemotherapy-induced nausea and vomiting (CINV) in highly emetogenic chemotherapy (HEC) patients. Support Care Cancer 2021; 29:4269-4275. [PMID: 33409724 DOI: 10.1007/s00520-020-05977-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/25/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Olanzapine-containing regimens have been reported to be effective in preventing CINV following highly emetogenic chemotherapy (HEC), but it is unsure whether it is cost-effective. There has been no cost-effectiveness analysis conducted for olanzapine using costs from the USA. The aim of this study is to determine whether olanzapine-containing antiemetic regimens are cost-effective in patients receiving HEC. METHODS A decision tree model was constructed to evaluate the cost and health outcomes associated with olanzapine-containing antiemetic regimens and otherwise-identical regimens. One-way sensitivity analyses were conducted to individually investigate the effect of (i) lower complete response (CR) rates of olanzapine, closer to non-olanzapine-containing regimens; (ii) higher FLIE scores for patients who achieved no/incomplete response, closer to FLIE scores of patients achieving a complete response; (iii) differing costs of olanzapine to reflect different costs per hospitals, globally, due to different insurance systems and drug costs; and (iv) varying costs for uncontrolled CINV, to account for varying durations of chemotherapy and accompanying uncontrolled CINV. RESULTS Olanzapine regimens have an expected cost of $325.24, compared with $551.23 for non-olanzapine regimens. Meanwhile, olanzapine regimens have an expected utility/index of 0.89, relative to 0.87 for non-olanzapine regimens. Olanzapine-containing regimens dominate non-olanzapine-containing regimens even if CR of olanzapine-containing regimens fall to 0.63. Only when CR is between 0.60 and 0.62 is olanzapine both more effective and more costly. CONCLUSION Olanzapine-containing regimens are both cheaper and more effective in the prophylaxis of CINV in HEC patients, compared with non-olanzapine-containing regimens. Future CINV trial resources should be allocated to understand newer antiemetics and compare them to olanzapine-containing regimens as the control arm. Further analysis should use nationally representative data to examine medication costs by payer type.
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Olanzapine for the prophylaxis and rescue of chemotherapy-induced nausea and vomiting: a systematic review, meta-analysis, cumulative meta-analysis and fragility assessment of the literature. Support Care Cancer 2021; 29:3439-3459. [PMID: 33442782 PMCID: PMC7805431 DOI: 10.1007/s00520-020-05935-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/03/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The aim of this study is to rigorously review the efficacy and safety of olanzapine in defined hematology oncology settings including (1) the setting of highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC) settings (2) at 5 mg and 10 mg doses, and (3) for response rates for use in the acute, delayed, and overall settings post-MEC and HEC. METHODS Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched through April 23, 2020. The primary efficacy endpoints were the rate of complete response, in the acute (0-24 h post-chemotherapy), delayed (24-120 h post-chemotherapy), and overall (0-120 h post-chemotherapy) phases. The secondary efficacy endpoints were the rates of no nausea and no emesis, for each phase. Safety endpoints were the rate of no serious adverse events (i.e., no grade 3 or 4 toxicities), as assessed by Common Terminology Criteria for Adverse Events (CTCAE) criteria. The Mantel-Haenszel, random-effects analysis model was used to compute risk ratios and accompanying 95% confidence intervals for each endpoint. For endpoints that statistically favored one arm, absolute risk differences were computed to assess whether there is a 10% or greater difference, used as the threshold for clinical significance by MASCC/ESMO. Fragility indices were also calculated for each statistically significant endpoint, to quantitatively assess the robustness of the summary estimate. A cumulative meta-analysis was conducted for each efficacy meta-analysis with more than 5 studies, also using the Mantel-Haenszel random-effects analysis model. RESULTS Three studies reported on olanzapine for the rescue of breakthrough chemotherapy-induced nausea and vomiting (CINV); 22 studies reported on olanzapine in the prophylactic setting. For studies reporting on HEC patients, olanzapine-containing regimens were statistically and clinically superior in seven of nine efficacy endpoints in the prophylaxis setting. When olanzapine is administered at a 10-mg dose, it is statistically and clinically superior to control patients in eight of nine endpoints among adults. Olanzapine may be effective in the MEC setting and when administered at 5-mg doses, but the paucity of data leads to notable uncertainty. CONCLUSION Further RCTs are needed in the setting of MEC patients and administration of olanzapine at a lower 5-mg dose, which may be given to reduce the sedative effect of olanzapine at 10 mg.
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Saudemont G, Prod'Homme C, Da Silva A, Villet S, Reich M, Penel N, Gamblin V. The use of olanzapine as an antiemetic in palliative medicine: a systematic review of the literature. BMC Palliat Care 2020; 19:56. [PMID: 32321488 PMCID: PMC7178955 DOI: 10.1186/s12904-020-00559-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/06/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Olanzapine is an atypical antipsychotic that has affinity for many central nervous system receptors. Its efficacy is supported by several studies in the prevention and treatment of chemotherapy-induced nausea and vomiting. No recommendations exist on the antiemetic use of olanzapine in the palliative care setting. The aim of this work is to complete the initial work of Fonte et al. published in 2015, to determine whether the literature supports the use of olanzapine as an antiemetic in palliative situations and, in practice, to propose a therapeutic schema adapted to the palliative setting. METHODS Systematic review of the literature according to the PRISMA criteria. We searched the PubMed, Cochrane, RefDoc, EMBase databases and the gray literature databases. The bibliographic search was conducted between November 2016 and August 2017. RESULTS Thirteen articles were included: 2 case studies, 3 case series, 3 retrospective studies, 2 prospective studies, 2 literature reviews. All studies concluded on the efficacy of olanzapine as an antiemetic in the palliative care setting. No serious adverse effects were reported. Based on the data from the literature review, we propose a therapeutic scheme adapted to the palliative care context. CONCLUSION Action of olanzapine on many receptors and its tolerance profile make it an interesting antiemetic treatment in palliative medicine. But to date, studies are scarce and have a low statistical power. Further investigation is therefore needed to determine the benefit of this treatment in palliative care patients, compared to usual treatments.
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Affiliation(s)
- G Saudemont
- Territorial Hub Pain Accompaniment Palliative care, Hospital center Antibes Juan-les-Pins, 107 avenue de Nice, F-06606, Antibes, France
| | - C Prod'Homme
- University Lille, CNRS, CHU Lille, Palliative care unit, F-59000, Lille, France.,ETHICS (Experiment, Transhumanism, Human Interactions, Care and Society) - EA 7446, Lille Catholic University, Lille, France
| | - A Da Silva
- Palliative care unit, Oscar Lambret center, 3 rue Frédéric Combemale, F-59020, Lille, France
| | - S Villet
- Palliative care unit, Oscar Lambret center, 3 rue Frédéric Combemale, F-59020, Lille, France
| | - M Reich
- Palliative care unit, Oscar Lambret center, 3 rue Frédéric Combemale, F-59020, Lille, France
| | - N Penel
- Direction of Research and Innovation, Oscar Lambret center, 3 rue Frédéric Combemale, F-59020, Lille, France.,Lille University Hospital and Medical School, F-59045, Lille, France
| | - V Gamblin
- Palliative care unit, Oscar Lambret center, 3 rue Frédéric Combemale, F-59020, Lille, France.
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Chow R, Valdez C, Chow N, Zhang D, Im J, Sodhi E, Lock M. Oral cannabinoid for the prophylaxis of chemotherapy-induced nausea and vomiting-a systematic review and meta-analysis. Support Care Cancer 2020; 28:2095-2103. [PMID: 31916006 DOI: 10.1007/s00520-019-05280-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/23/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Chemotherapy-induced nausea and vomiting (CINV) is a burdensome adverse event frequently associated with chemotherapy treatment of cancer. Evidence suggests that cannabinoid CB2 receptors are present in brainstem neurons, and thus, there may exist a role for cannabinoids to counter CINV. The aim of this paper is to conduct a systematic review and meta-analysis of the efficacy and safety of oral cannabinoids compared with other treatments as documented in randomized controlled trials (RCTs). METHODS A literature search was conducted using Ovid MEDLINE up until December 31, 2018; Embase Classic and Embase up until 2018 week 53; and Cochrane Central Register of Controlled Trials up until November 2018. Study data were extracted and included in this meta-analysis if they reported on at least one of the following efficacy endpoints: no nausea and no vomiting, no nausea, and no vomiting. The Mantel-Haenszel method and random effects analysis model were used, to generate odds ratio (OR) and accompanying 95% confidence intervals (CI). RESULTS In the setting of prophylactic treatment against both nausea and vomiting, oral cannabinoid was more efficacious than placebo or other studied antiemetic treatments. When controlling for vomiting, oral cannabinoid was equally as efficacious as others. Against nausea, oral cannabinoid was equally as effective as other treatments. A greater percentage of patients administered oral cannabinoid for CINV experienced dysphoria, euphoria, and sedation. CONCLUSION Although there exists some evidence suggesting that oral cannabinoids may have a role in controlling for emesis from a neurophysiological perspective, these conclusions are currently not mirrored in the published RCTs to date. However, there exists only a limited number of RCTs, comparisons with older treatment regimens and a lack of standard reporting practice across published literature. Further RCTs should investigate the efficacy and safety of oral cannabinoids, to secure a better picture of the efficacy of oral cannabinoids against CINV.
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Affiliation(s)
- Ronald Chow
- London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
| | - Crystal Valdez
- London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - Natalie Chow
- London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - Daniel Zhang
- London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - James Im
- London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - Emily Sodhi
- London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - Michael Lock
- London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
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Alhifany AA, McBride A, Almutairi AR, Cheema E, Shahbar A, Alatawi Y, Alharbi AS, Babiker H, MacDonald K, Aapro M, Abraham I. Efficacy of olanzapine, neurokinin-1 receptor antagonists, and thalidomide in combination with palonosetron plus dexamethasone in preventing highly emetogenic chemotherapy-induced nausea and vomiting: a Bayesian network meta-analysis. Support Care Cancer 2019; 28:1031-1039. [PMID: 31823054 DOI: 10.1007/s00520-019-05210-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 11/24/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Olanzapine, neurokinin-1-receptor-antagonists (NK-1-RA), and thalidomide added to palonosetron + dexamethasone (PALO-DEX) have been evaluated in separate studies as prophylaxis for chemotherapy-induced nausea and vomiting (CINV) due to highly emetogenic chemotherapy (HEC). We conducted a Bayesian network meta-analysis to compare the prophylactic efficacy of these agents in combination with PALO-DEX. METHODS PubMed, Medline/Ovid, Embase, and Clinicaltrials.gov were searched from inception through 22 Mar 2018. Study quality was assessed using the Cochrane methodology. A Bayesian network meta-analysis using random-effects models was used to asses complete response (CR) and rate of no nausea (RNN) in acute, delayed, and overall phases and were expressed as odds ratios (OR) and 95% credible interval (95% CrI). Ranking probabilities of treatments were calculated using the surface under the cumulative ranking curve (SUCRA) to identify the probability of a given treatment as the best option against the worst option. RESULTS Nine RCTs involving two thousand nine hundred fifty-nine patients were included. The olanzapine-based regimen showed greater CR in the acute, delayed, and overall-phases versus the PALO-DEX regimen (OR = 3.97, 95% CrI = 1.02-19.13; OR = 5.62, 95% CrI = 1.66-28.58; OR = 4.79, 95% CrI = 1.40-24.02, respectively). Additionally, it showed greater RNN than the NK-1-RA-based and the PALO-DEX regimens in the delayed phase only (OR = 2.90, 95% CrI = 1.34-5.15; OR = 4.53, 95% CrI = 1.89-10.55, respectively). Olanzapine-, NK-1-RA-, and thalidomide-based regimens did not differ in CR in the three phases. SUCRA probabilities ranked the olanzapine-based regimen as the best option in terms of CR and RNN, while ranking the NK-1-RA-based regimens as the second best option in terms of CR throughout the three phases. CONCLUSION Based on the data included in the analyses, there is insufficient evidence to support adding thalidomide or NK-1-RA to PALO-DEX in preventing CINV induced by HEC. However, adding olanzapine to PALO-DEX achieves better CR and RNN. Olanzapine side-effects and the absence of direct comparisons explain why some guidelines are cautious in suggesting the use of olanzapine.
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Affiliation(s)
- Abdullah A Alhifany
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia. .,Center for Health Outcomes and Pharmaco-Economic Research, University of Arizona, Tucson, AZ, USA.
| | - Ali McBride
- Center for Health Outcomes and Pharmaco-Economic Research, University of Arizona, Tucson, AZ, USA.,Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA.,University of Arizona Cancer Center, Tucson, AZ, USA
| | - Abdulaali R Almutairi
- Center for Health Outcomes and Pharmaco-Economic Research, University of Arizona, Tucson, AZ, USA.,Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Ejaz Cheema
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Alaa Shahbar
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Yasser Alatawi
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Adnan S Alharbi
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Hani Babiker
- University of Arizona Cancer Center, Tucson, AZ, USA
| | | | - Matti Aapro
- Genolier Cancer Centre, Clinique de Genolier, Genolier, Switzerland
| | - Ivo Abraham
- Center for Health Outcomes and Pharmaco-Economic Research, University of Arizona, Tucson, AZ, USA.,Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA.,University of Arizona Cancer Center, Tucson, AZ, USA.,Matrix45, Tucson, AZ, USA.,Department of Family and Community Medicine, College of Medicine-Tucson, University of Arizona, Tucson, AZ, USA
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Lown EA, Banerjee A, Vittinghoff E, Dvorak CC, Hartogensis W, Melton A, Mangurian C, Hu H, Shear D, Adcock R, Morgan M, Golden C, Hecht FM. Acupressure to Reduce Treatment-Related Symptoms for Children With Cancer and Recipients of Hematopoietic Stem Cell Transplant: Protocol for a Randomized Controlled Trial. Glob Adv Health Med 2019; 8:2164956119870444. [PMID: 31453017 PMCID: PMC6696841 DOI: 10.1177/2164956119870444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 06/02/2019] [Accepted: 07/02/2019] [Indexed: 01/16/2023] Open
Abstract
Background We describe the study design and protocol of a pragmatic randomized controlled trial (RCT) Acupressure for Children in Treatment for a Childhood Cancer (ACT-CC). Objective To describe the feasibility and effectiveness of an acupressure intervention to decrease treatment-related symptoms in children in treatment for cancer or recipients of a chemotherapy-based hematopoietic stem cell transplant (HSCT). Design Two-armed RCTs with enrollment of 5 to 30 study days. Setting Two pediatric teaching hospitals. Patients Eighty-five children receiving cancer treatment or a chemotherapy-based HSCT each with 1 parent or caregiver. Intervention Patients are randomized 1:1 to receive either usual care plus daily professional acupressure and caregiver delivered acupressure versus usual care alone for symptom management. Participants receive up to 20 professional treatments. Main Outcome A composite nausea/vomiting measure for the child. Secondary Outcomes Child's nausea, vomiting, pain, fatigue, depression, anxiety, and positive affect. Parent Outcomes Depression, anxiety, posttraumatic stress symptoms, caregiver self-efficacy, and positive affect. Feasibility of delivering the semistandardized intervention will be described. Linear mixed models will be used to compare outcomes between arms in children and parents, allowing for variability in diagnosis, treatment, and age. Discussion Trial results could help childhood cancer and HSCT treatment centers decide about the regular inclusion of trained acupressure providers to support symptom management.
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Affiliation(s)
- E Anne Lown
- Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California
| | - Anu Banerjee
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California
| | - Christopher C Dvorak
- Division of Pediatric Allergy, Immunology, & Blood and Marrow Transplantation, University of California, San Francisco, California
| | - Wendy Hartogensis
- Osher Center for Integrative Medicine, University of California, San Francisco, California
| | - Alexis Melton
- Division of Pediatric Allergy, Immunology, & Blood and Marrow Transplantation, University of California, San Francisco, California
| | - Christina Mangurian
- Department of Psychiatry, School of Medicine, University of California, San Francisco, California
| | - Hiroe Hu
- Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California
| | - Deborah Shear
- Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California
| | - Robyn Adcock
- Compass Care/Integrative Pediatric Pain and Palliative Care (IP3), UCSF Benioff Children's Hospital, San Francisco, California
| | - Michael Morgan
- Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California
| | - Carla Golden
- Department of Pediatric Hematology-Oncology, UCSF Benioff Children's Hospital, Oakland, California
| | - Frederick M Hecht
- Osher Center for Integrative Medicine, University of California, San Francisco, California
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Chow R, Aapro M, Navari RM, Gralla R, Chiu N, Chiu L, Chan S, Popovic M, Lam H, Lock M, DeAngelis C. Do we still need to study palonosetron for chemotherapy-induced nausea and vomiting? A cumulative meta-analysis. Crit Rev Oncol Hematol 2019; 142:164-186. [PMID: 31419719 DOI: 10.1016/j.critrevonc.2019.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 07/14/2019] [Accepted: 07/18/2019] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The aim is to conduct an updated systematic review comparing palonosetron to other 5-HT3RAs for the prophylaxis of CINV, assess for publication biases, and determine whether further RCTs are required, that could potentially lead to a different meta-conclusion. METHODS Random-effects analysis model was used to generate odds ratio (OR), risk differences (RD) and accompanying 95% confidence intervals (CI). Funnel plots to assess for biases and cumulative meta-analyses to assess effect size over time were generated. RESULTS 4145 patients were randomized to palonosetron and 4911 received other 5-HT3RAs. In the majority of efficacy endpoints, the meta-conclusion has not changed over time - recent clinical trials simply narrow CIs the meta-conclusion. Safety profile boasts a stable conclusion over time. No publication biases exist. CONCLUSION Considering the vast amount of resources needed to conduct RCTs, resources should be dedicated to other prophylactic treatments/settings which have not been as well explored.
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Affiliation(s)
- Ronald Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, London, ON, Canada.
| | - Matti Aapro
- Cancer Centre, Clinique de Genolier, Genolier, Switzerland
| | - Rudolph M Navari
- University of Alabama Birmingham School of Medicine, Birmingham, AL, USA
| | | | - Nicholas Chiu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Leonard Chiu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Stephanie Chan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Marko Popovic
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Henry Lam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Michael Lock
- London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Carlo DeAngelis
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
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Hamai Y, Yoshiya T, Hihara J, Emi M, Furukawa T, Yamakita I, Ibuki Y, Okada M. Traditional Japanese herbal medicine rikkunshito increases food intake and plasma acylated ghrelin levels in patients with esophageal cancer treated by cisplatin-based chemotherapy. J Thorac Dis 2019; 11:2470-2478. [PMID: 31372284 DOI: 10.21037/jtd.2019.05.67] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Cisplatin (CDDP) is an important chemotherapeutic drug for treating esophageal cancer that often induces nausea and vomiting. Rikkunshito (RKT), a traditional Japanese herbal medicine, can increase levels of plasma ghrelin, which is an orexigenic gut hormone that can alleviate chemotherapy-induced nausea and vomiting (CINV) and anorexia. Methods This prospective randomized crossover study included 20 patients with esophageal cancer who were administered with CDDP-based chemotherapy. Ten of them were assigned to group A [1st course: with RKT 7.5 g/day on days 1-14; 2nd course: without RKT (control)] and 10 were assigned to group B [1st course: without RKT (control); 2nd course: with RKT 7.5 g/day on days 22-35]. Food intake and levels of plasma acylated ghrelin (AG) were compared between the control and RKT courses. Results Data from 18 patients were included in this analysis, as chemotherapy was immediately stopped due to deteriorating renal function in one patient and intracerebral bleeding in another. The median rate at which food intake decreased between days 4 and 6 was considerably lower in the course with, than without RKT (2% vs. 30%; P=0.02). Median levels of AG significantly increased from days 3 to 8 in patients in both courses with and without RKT (9.6 to 15.7 fmol/mL, P<0.0001; control, 10.2 to 17.8, P=0.0002). The rate at which median plasma AG levels increased from days 3 to 8 tend to be higher in the RKT, than in the control course (68% vs. 48%, P=0.08). Conclusions RKT can improve CDDP-induced, delayed-onset anorexia and increase plasma AG levels among patients with esophageal cancer who undergo highly emetogenic chemotherapy (HEC).
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Affiliation(s)
- Yoich Hamai
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Tomoharu Yoshiya
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Jun Hihara
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Manabu Emi
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Takaoki Furukawa
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Ichiko Yamakita
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yuta Ibuki
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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18
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Abstract
PURPOSE OF REVIEW The present review summarizes and discuss the most recent updated antiemetic consensus. RECENT FINDINGS Two new neurokinin (NK)1-receptor antagonists, netupitant and rolapitant, have been approved by the Food and Drug Administration and the European Medicines Agency and incorporated in the latest versions of the MASCC/ESMO, ASCO, and NCCN guidelines. Guidelines all recommend a combination of a serotonin (5-HT)3-receptor antagonist, dexamethasone, and a NK1-receptor antagonist in patients receiving highly emetogenic chemotherapy (HEC) with the addition of the multireceptor targeting agent, olanzapine, as an option in cisplatin or anthracycline-cyclophosphamide chemotherapy. A combination of a 5-HT3-receptor antagonist, dexamethasone, and a NK1-receptor antagonist is also recommended in patients receiving carboplatin-based chemotherapy, although based on a lower level of evidence. In spite of the development of new antiemetics, nausea has remained a significant adverse effect. Olanzapine is an effective antinausea agent, but sedation can be a problem. Therefore, the effect and tolerability of multitargeting, nonsedative agents like amisulpride, should be explored. SUMMARY Guidelines recommend a combination of a 5-HT3-receptor antagonist, dexamethasone, and an NK1-receptor antagonist in HEC and carboplatin-based chemotherapy. The addition of olanzapine can be useful in cisplatin-based and anthracycline-cyclophosphamide-based chemotherapy in particular if the main problem is nausea.
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19
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Celio L, Saibene G, Lepori S, Festinese F, Niger M, Raspagliesi F, Lorusso D. Short-course olanzapine to prevent delayed emesis following carboplatin/paclitaxel for gynecologic cancer: a randomised study. TUMORI JOURNAL 2019; 105:253-258. [PMID: 30945623 DOI: 10.1177/0300891619839301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To explore efficacy of short-course olanzapine with or without low-dose dexamethasone for prevention of delayed emesis in gynecologic cancer patients receiving carboplatin/paclitaxel. METHODS This was a prospective study in 81 chemo-naive patients receiving 0.25 mg intravenous palonosetron, 16 mg dexamethasone, and 10 mg oral olanzapine before chemotherapy. On days 2 and 3, patients randomly received 10 mg olanzapine (arm A; n=27), 10 mg olanzapine plus 4 mg dexamethasone (arm B; n=27), or 8 mg dexamethasone (reference arm C; n=27). The primary endpoint was total control (TC; no vomiting, no rescue antiemetics, and no nausea) on days 2-5, using a diary. Secondary endpoints included proportion of patients with no emesis impact on daily life using the Functional Living Index-Emesis (FLIE) questionnaire, and patient's satisfaction with antiemetic coverage. RESULTS Fifty-two percent of patients in arm A (P=0.406), 59% in arm B (P=0.779), and 67% in arm C had a delayed TC. Secondary analyses showed no significant difference across arms in any efficacy endpoint. FLIE scores as well as mean satisfaction scores were similar across arms. CONCLUSIONS In this exploratory study with a small sample size, we did not find any clue about better control of delayed emesis with either olanzapine regimen in gynecologic cancer patients treated with carboplatin/paclitaxel and receiving the same prophylaxis for acute emesis.
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Affiliation(s)
- Luigi Celio
- 1 Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriella Saibene
- 2 Unit of Pharmacy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Lepori
- 3 Gynaecological Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Fabrizio Festinese
- 2 Unit of Pharmacy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Niger
- 1 Medical Oncology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Raspagliesi
- 3 Gynaecological Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Domenica Lorusso
- 3 Gynaecological Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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20
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Okamoto H, Shono K, Nozaki-Taguchi N. Low-dose of olanzapine has ameliorating effects on cancer-related anorexia. Cancer Manag Res 2019; 11:2233-2239. [PMID: 30962712 PMCID: PMC6433113 DOI: 10.2147/cmar.s191330] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Olanzapine (OLZ) has become well-known for its antiemetic effects on chemotherapy-induced nausea and vomiting. However, it remains unclear whether OLZ also has efficacy for treating cancer-related anorexia. This study, therefore, retrospectively examined whether or not OLZ administration affects the food intake in anorexic cancer patients who exhibit neither nausea nor vomiting. Methods Eighty patients prescribed OLZ were extracted from 951 inpatients who consulted with our palliative care team at Chiba University Hospital from April 2008 to March 2016. Their food intake described on a nursing record was compared before and after OLZ administration. The observation period was 3 days before and after the start of OLZ treatment, because most inpatients whose food intake increased were discharged in 3 days. Results In those 80 patients, the average dose of OLZ for 3 days was 2.28±0.87 (mean±SD) mg/day. First, the food intake in 80 patients was significantly higher after than before starting OLZ, and the relative change in food intake was 149% on average (P<0.0001, Student’s paired t-test). Second, OLZ increased the food intake even in 40 out of 80 patients without nausea or vomiting, and the relative change in food intake was 143% on average (P<0.001, Student’s paired t-test). Third, the average food intake increased in 13 out of 40 patients who were prescribed 1.5 mg/day of OLZ, and the relative change in food intake was 124% on average (P<0.01, Student’s paired t-test). There was no significant difference in food intake between a dose of 1.5 mg/day and a dose of >1.5 mg/day of OLZ (P=0.18, Welch’s unpaired t-test). Conclusion We have herein reported OLZ’s ameliorating efficacy in cancer-related anorexia at the low dose of 1.5 mg/day. Although our study has many limitations, low-dose OLZ can be a promising treatment for cancer-related anorexia.
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Affiliation(s)
- Hideki Okamoto
- Department of Kampo Medicine (Japanese Traditional Medicine), School of Medicine, International University of Health and Welfare, Tokyo, Japan,
| | - Koyo Shono
- Palliative Care Center, Chiba University Hospital, Chiba, Japan
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Abstract
Nausea and vomiting result from complex interactions between afferent and efferent pathways of the gastrointestinal tract, central nervous system, and autonomic nervous system. Afferent pathways from the vagus nerve, vestibular system, and chemoreceptor trigger zone project to nucleus tractus solitarius, which in turn relays signals to the central pattern generator to initiate multiple downstream pathways resulting in symptoms of nausea and vomiting. There is increasing evidence that the central pathway of chronic nausea is different from that of acute nausea and vomiting-and closely resembles that of neuropathic pain. This improved understanding of chronic nausea has resulted in a paradigm shift with regard to management strategy. Although conventional therapies such as antiemetics and prokinetics are commonly used to manage acute nausea and vomiting, they are historically not as effective in treating chronic nausea. Recently, neuromodulator agents, such as tricyclic antidepressants, gabapentin, olanzapine, mirtazapine, and benzodiazepines, and cannabinoids have been shown to be efficacious in the treatment of nausea and vomiting, and may be useful in the treatment of chronic symptoms. There is a need to study these agents, especially in the management of chronic functional nausea. Improved understanding of the central and peripheral circuitry of nausea and vomiting symptoms will allow for enhanced utilization of the currently available medications, and the development of novel therapeutic options.
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Sutherland A, Naessens K, Plugge E, Ware L, Head K, Burton MJ, Wee B. Olanzapine for the prevention and treatment of cancer-related nausea and vomiting in adults. Cochrane Database Syst Rev 2018; 9:CD012555. [PMID: 30246876 PMCID: PMC6513437 DOI: 10.1002/14651858.cd012555.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Olanzapine as an antiemetic represents a new use of an antipsychotic drug. People with cancer may experience nausea and vomiting whilst receiving chemotherapy or radiotherapy, or whilst in the palliative phase of illness. OBJECTIVES To assess the efficacy and safety of olanzapine when used as an antiemetic in the prevention and treatment of nausea and vomiting related to cancer in adults. SEARCH METHODS We searched CENTRAL, MEDLINE and Embase for published data on 20th September 2017, as well as ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform for unpublished trials. We checked reference lists, and contacted experts in the field and study authors. SELECTION CRITERIA We included randomised controlled trials (RCTs) of olanzapine versus any comparator with or without adjunct therapies for the prevention or treatment, or both, of nausea or vomiting in people with cancer aged 18 years or older, in any setting, of any duration, with at least 10 participants per treatment arm. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology. We used GRADE to assess quality of evidence for each main outcome. We extracted data for absence of nausea or vomiting and frequency of serious adverse events as primary outcomes. We extracted data for patient perception of treatment, other adverse events, somnolence and fatigue, attrition, nausea or vomiting severity, breakthrough nausea and vomiting, rescue antiemetic use, and nausea and vomiting as secondary outcomes at specified time points. MAIN RESULTS We included 14 RCTs (1917 participants) from high-, middle- and low-income countries, representing over 24 different cancers. Thirteen studies were in chemotherapy-induced nausea and vomiting. Oral olanzapine was administered during highly emetogenic (HEC) or moderately emetogenic (MEC) chemotherapy (12 studies); chemoradiotherapy (one study); or palliation (one study). Eight studies await classification and 13 are ongoing.The main comparison was olanzapine versus placebo/no treatment. Other comparisons were olanzapine versus NK1 antagonist, prokinetic, 5-HT3 antagonist or dexamethasone.We assessed all but one study as having one or more domains that were at high risk of bias. Eight RCTs with fewer than 50 participants per treatment arm, and 10 RCTs with issues related to blinding, were at high risk of bias. We downgraded GRADE assessments due to imprecision, inconsistency and study limitations.Olanzapine versus placebo/no treatmentPrimary outcomesOlanzapine probably doubles the likelihood of no nausea or vomiting during chemotherapy from 25% to 50% (risk ratio (RR) 1.98, 95% confidence interval (CI) 1.59 to 2.47; 561 participants; 3 studies; solid tumours; HEC or MEC therapy; moderate-quality evidence) when added to standard therapy. Number needed to treat for additional beneficial outcome (NNTB) was 5 (95% CI 3.3 - 6.6).It is uncertain if olanzapine increases the risk of serious adverse events (absolute risk difference 0.7% more, 95% CI 0.2 to 5.2) (RR 2.46, 95% CI 0.48 to 12.55; 7 studies, 889 participants, low-quality evidence).Secondary outcomesFour studies reported patient perception of treatment. One study (48 participants) reported no difference in patient preference. Four reported quality of life but data were insufficient for meta-analysis.Olanzapine may increase other adverse events (RR 1.71, 95% CI 0.99 to 2.96; 332 participants; 4 studies; low-quality evidence) and probably increases somnolence and fatigue compared to no treatment or placebo (RR 2.33, 95% CI 1.30 to 4.18; anticipated absolute risk 8.2% more, 95% CI 1.9 to 18.8; 464 participants; 5 studies; moderate-quality evidence). Olanzapine probably does not affect all-cause attrition (RR 0.99, 95% CI 0.57 to 1.73; 943 participants; 8 studies; I² = 0%). We are uncertain if olanzapine increases attrition due to adverse events (RR 3.00, 95% CI 0.13 to 70.16; 422 participants; 6 studies). No participants withdrew due to lack of efficacy.We are uncertain if olanzapine reduces breakthrough nausea and vomiting (RR 0.38, 95% CI 0.10 to 1.47; 501 participants; 2 studies; I² = 54%) compared to placebo or no treatment. No studies reported 50% reduction in severity of nausea or vomiting, use of rescue antiemetics, or attrition.We are uncertain of olanzapine's efficacy in reducing acute nausea or vomiting. Olanzapine probably reduces delayed nausea (RR 1.71, 95% CI 1.40 to 2.09; 585 participants; 3 studies) and vomiting (RR 1.28, 95% CI 1.14 to 1.42; 702 participants; 5 studies).Subgroup analysis: 5 mg versus 10 mgPlanned subgroup analyses found that it is unclear if 5 mg is as effective an antiemetic as 10 mg. There is insufficient evidence to exclude the possibility that 5 mg may confer a lower risk of somnolence and fatigue than 10 mg.Other comparisonsOne study (20 participants) compared olanzapine versus NK1 antagonists. We observed no difference in any reported outcomes.One study (112 participants) compared olanzapine versus a prokinetic (metoclopramide), reporting that olanzapine may increase freedom from overall nausea (RR 2.95, 95% CI 1.73 to 5.02) and overall vomiting (RR 3.03, 95% CI 1.78 to 5.14).One study (62 participants) examined olanzapine versus 5-HT3 antagonists, reporting olanzapine may increase the likelihood of 50% or greater reduction in nausea or vomiting at 48 hours (RR 1.82, 95% CI 1.11 to 2.97) and 24 hours (RR 1.36, 95% CI 0.80 to 2.34).One study (229 participants) compared olanzapine versus dexamethasone, reporting that olanzapine may reduce overall nausea (RR 1.73, 95% CI 1.37 to 2.18), overall vomiting (RR 1.27, 95% CI 1.10 to 1.48), delayed nausea (RR 1.66, 95% CI 1.33 to 2.08) and delayed vomiting (RR 1.25, 95% CI 1.07 to 1.45). AUTHORS' CONCLUSIONS There is moderate-quality evidence that oral olanzapine probably increases the likelihood of not being nauseous or vomiting during chemotherapy from 25% to 50% in adults with solid tumours, in addition to standard therapy, compared to placebo or no treatment. There is uncertainty whether it increases serious adverse events. It may increase the likelihood of other adverse events, probably increasing somnolence and fatigue. There is uncertainty about relative benefits and harms of 5 mg versus 10 mg.We identified only RCTs describing oral administration. The findings of this review cannot be extrapolated to provide evidence about the efficacy and safety of any injectable form (intravenous, intramuscular or subcutaneous) of olanzapine.
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Affiliation(s)
- Anna Sutherland
- Katharine House HospiceMandeville RoadAynho Road, AdderburyBanburyUKOX17 3NL
- Cochrane Fellowship, Cochrane UKOxfordUK
| | - Katrien Naessens
- Oxford Radcliffe Trust/Health Education Thames ValleyPalliative CareOxfordUK
| | - Emma Plugge
- Cochrane UKSummertown Pavilion18 ‐ 24 Middle WayOxfordUKOX2 7LG
| | - Lynda Ware
- Cochrane UKSummertown Pavilion18 ‐ 24 Middle WayOxfordUKOX2 7LG
| | - Karen Head
- Nuffield Department of Surgical Sciences, University of OxfordCochrane ENTUK Cochrane Centre, Summertown Pavilion18 ‐ 24 Middle WayOxfordUK
| | - Martin J Burton
- Cochrane UKSummertown Pavilion18 ‐ 24 Middle WayOxfordUKOX2 7LG
| | - Bee Wee
- Churchill HospitalNuffield Department of Medicine and Sir Michael Sobell HouseOld RoadHeadingtonOxfordUKOX3 7LJ
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Wang W, Lou G, Zhang Y. Olanzapine with ondansetron and dexamethasone for the prevention of cisplatin-based chemotherapy-induced nausea and vomiting in lung cancer. Medicine (Baltimore) 2018; 97:e12331. [PMID: 30212982 PMCID: PMC6156067 DOI: 10.1097/md.0000000000012331] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Olanzapine is an atypical antipsychotic that has shown efficacy for the treatment of nausea, anxiety, and insomnia. This study was conducted to evaluate the efficacy of olanzapine (5 mg) combined with 5-HT3 receptor antagonists and dexamethasone for the prevention of chemotherapy-induced nausea and vomiting (CINV) in lung patients receiving cisplatin-based (25 mg/m2 d1-3) highly emetogenic chemotherapy (HEC).Olanzapine (5 mg) was administered a day prior to cisplatin administration and continued on days 1 to 5. We evaluated complete response (CR) rate and rates of no nausea and no vomiting in 3 periods. In addition, Self-Rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and The Functional Living Index-Emesis (FLIE) questionnaire were also assessed.A total of 40 lung cancer patients were included. CR for acute, delayed, and over all phases were 82.5%, 75.0%, and 70.0%, respectively. The rate of no nausea in the acute phase was 70.0% and 62.5% in delayed phase. The rate of no vomiting in the acute phase was 85.0%, and 77.5% in delayed phase. The rate of no nausea and no vomiting in the overall phase were 57.5% and 75.0%, respectively. The median SAS and SDS score were 37.9 and 41.6 in pre-chemotherapy, respectively. Up to day 6 after chemotherapy treatment, the median SAS and SDS score were 36.9 and 42.0, respectively. The median FLIE score was 111.7. The main side effects were grade 1 somnolence (35.0%) and mild constipation (52.5%).Around 5 mg olanzapine may be used as a potential, safe, and cost-beneficial alternative to prevent nausea and vomiting for HEC, particular for multiday chemotherapy regimen.
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24
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Evidence-based Palliative Care Approaches to Non-pain Physical Symptom Management in Cancer Patients. Semin Oncol Nurs 2018; 34:227-240. [DOI: 10.1016/j.soncn.2018.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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25
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Clemmons AB, Orr J, Andrick B, Gandhi A, Sportes C, DeRemer D. Randomized, Placebo-Controlled, Phase III Trial of Fosaprepitant, Ondansetron, Dexamethasone (FOND) Versus FOND Plus Olanzapine (FOND-O) for the Prevention of Chemotherapy-Induced Nausea and Vomiting in Patients with Hematologic Malignancies Receiving Highly Emetogenic Chemotherapy and Hematopoietic Cell Transplantation Regimens: The FOND-O Trial. Biol Blood Marrow Transplant 2018; 24:2065-2071. [PMID: 29906570 DOI: 10.1016/j.bbmt.2018.06.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 06/05/2018] [Indexed: 12/16/2022]
Abstract
Evidence supports olanzapine for prophylaxis of chemotherapy-induced nausea/vomiting (CINV) for highly emetogenic chemotherapy; however, most studies focus on solid malignancies and single-day regimens. A randomized, double-blinded, placebo-controlled trial was conducted to compare the addition of olanzapine to triplet therapy (fosaprepitant, ondansetron, dexamethasone [FOND-O]) versus triplet therapy alone (FOND) in preventing CINV in hematology patients receiving single-day and multiple-day highly emetogenic chemotherapy and hematopoietic cell transplant (HCT) regimens (NCT02635984). The primary objective of this study was to compare complete response (CR; no emesis and minimal nausea, <25 mm on a 100-mm visual analog scale) during the overall assessment period (chemotherapy days plus 5 days after). Secondary objectives were the number of emesis, number of rescue medications, percent achieving minimal nausea, and percent achieving complete protection (CP; no emesis, rescue antiemetic, or significant nausea), all of which are reported as acute (chemotherapy days), delayed (5 days after chemotherapy), and overall phases. Olanzapine 10 mg or matching placebo were given on each chemotherapy day and 3 days after. Adults with hematologic malignancy receiving HCT regimens of melphalan, BEAM (carmustine, etoposide, cytarabine, melphalan), busulfan (Bu)/cyclophosphamide (Cy), Bu/fludarabine (Flu), Bu/melphalan, FluCy, FluCy-total body irradiation (TBI), etoposide-TBI, and ICE (ifosfamide, carboplatin, etoposide) or 7+3 chemotherapy regimens were included. An estimated 98 patients were required using alpha = .05 and 80% power. No significant differences existed in baseline characteristics between FOND-O (n = 51) and FOND (n = 50) arms. Mean duration of olanzapine was 7.7 days (range, 4 to 11). Discontinuation for possible adverse events occurred in 3 placebo and 0 olanzapine patients. CR was significantly higher for FOND-O in overall (55% versus 26%, P = .003) and delayed (60.8% versus 30%, P = .001) but not acute (P = .13) phases. Significantly more patients receiving FOND-O achieved no more than minimal nausea in overall (P = .001) and delayed phases (P = .0002), as well as fewer overall mean emesis counts (P = .005). CP rates were not different in any assessment phase (P ≥ .05 each). Within the HCT subgroup (n = 64), the CR, CP, and no significant nausea rates were significantly better for FONDO-O in overall and delayed phases (all P < .05). Analysis within the HCT subgroup revealed significant improvement in outcomes in delayed and overall phases with FOND-O in the autologous but not allogeneic cohort. Addition of olanzapine to an NK-1-based triplet antiemetic regimen significantly improved clinically relevant outcomes in the HCT population.
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Affiliation(s)
- Amber B Clemmons
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Augusta, Georgia; Department of Pharmacy, Augusta University Medical Center, Augusta, Georgia.
| | - Julianne Orr
- Department of Pharmacy, Indiana University, Indianapolis, Indiana
| | - Benjamin Andrick
- Geisinger Enterprise Pharmacy, Center for Pharmacy Innovations and Outcomes, Danville, Pennsylvania
| | - Arpita Gandhi
- Department of Pharmacy, Augusta University Medical Center, Augusta, Georgia
| | - Claude Sportes
- Department of Medicine, Division of Hematology and Medical Oncology, Augusta University Medical Center, Augusta, Georgia
| | - David DeRemer
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida
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Chow R, Warr DG, Navari RM, Tsao M, Popovic M, Chiu L, Milakovic M, Lam H, DeAngelis C. Should palonosetron be a preferred 5-HT 3 receptor antagonist for chemotherapy-induced nausea and vomiting? An updated systematic review and meta-analysis. Support Care Cancer 2018; 26:2519-2549. [PMID: 29796708 DOI: 10.1007/s00520-018-4237-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 04/26/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE Chemotherapy-induced nausea and vomiting (CINV) continues to be a common side effect of systemic anticancer therapy, decreasing quality of life and increasing resource utilization. The aim of this meta-analysis was to investigate the comparative efficacy and safety of palonosetron relative to other 5-HT3RAs. METHODS A literature search was carried out in Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Full-text references were then screened and included in this meta-analysis if they were an RCT and had adequate data regarding one of the five primary endpoints-complete response (CR), complete control (CC), no emesis, no nausea, or no rescue medications. RESULTS A total of 24 RCTs were included in this review. Palonosetron was statistically superior to other 5-HT3RAs for 10 of the 19 assessed endpoints. Only one endpoint-emesis in the overall phase-had noticeable more favorable data for palonosetron to the point that it approached the 10% risk difference (RD) threshold as specified by the MASCC/ESMO antiemetic panel; another two endpoints (CR in the overall phase and nausea in the delayed phase) approached the 10% threshold. CONCLUSIONS Palonosetron seems to be more efficacious and safe than other 5-HT3RAs-statistically superior in 10 of 19 endpoints. It is, however, only clinically significant in one endpoint and approached clinically significant difference in another two endpoints. Within the limits of this meta-analysis, our results indicate that palonosetron may not be as superior in efficacy and safety as reported in a previous meta-analysis, and supports the recent MASCC/ESMO, ASCO, and NCCN guidelines in not generally indicating palonosetron as the 5-HT3RA of choice.
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Affiliation(s)
- Ronald Chow
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
| | - David G Warr
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Rudolph M Navari
- University of Alabama Birmingham School of Medicine, Birmingham, AL, USA
| | - May Tsao
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Marko Popovic
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Leonard Chiu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Milica Milakovic
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Henry Lam
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Carlo DeAngelis
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
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27
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Chemotherapy-induced nausea and vomiting (CINV) in patients with advanced lung cancer during the first-line treatment: assessment by physicians, nurses, and patients from an Italian multicenter survey. Support Care Cancer 2017; 26:1841-1849. [PMID: 29270827 DOI: 10.1007/s00520-017-4004-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Chemotherapy-induced nausea and vomiting (CINV) still represents a common side-effect of chemotherapy, and often, its perception differs between patients and healthcare professionals. The aim of this study was to evaluate the agreement on the perception of CINV and other items among clinicians, patients, and nurses. METHODS This observational prospective study was part of an evaluation program promoted by the Women Against Lung Cancer in Europe (WALCE) Onlus. From August 2015 to February 2016, a survey was administered in 11 oncologic institutions to 188 stage IV lung cancer patients and to their oncologists and nurses during first-line chemotherapy. Our survey investigated 11 aspects: anxiety, mood, weakness, appetite, nausea, vomiting, pain, drowsiness, breath, general condition, and trust in treatments. These items were assessed through Numerical Rating Scale at four consecutive evaluations: at T0 (immediately prior to the first cycle), at T1 (immediately prior to the second cycle), at T2 (immediately prior to the third cycle), and at T3 (immediately prior to the fourth cycle). Clinician versus patient (CvP), nurse versus patient (NvP), and clinician versus nurse (CvN) agreements were estimated applying Weighted Cohen's kappa. A multivariate logistic model and generalized equation estimates were applied to evaluate factors possibly influencing CINV development. RESULTS The incidence of patients reporting CINV varied from 40% at T0 to 71% at T3. Both CvP and NvP agreement on the investigated items were mainly moderate, slightly increasing over time, and becoming substantial for some items, in particular for NvP. Pre-chemotherapy anxiety in its mild, moderate, and severe manifestations, as well as mild, moderate, and severe anxiety experienced after chemotherapy start, exposed patients to a higher risk of anticipatory and acute/delayed CINV, respectively. CONCLUSIONS Despite clinical staff awareness of patients' status and perceptions, CINV still represents a clinical problem. This study confirms that particular attention should be paid to anxiety due to its key role in CINV development.
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28
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Zhang L, Qu X, Teng Y, Shi J, Yu P, Sun T, Wang J, Zhu Z, Zhang X, Zhao M, Liu J, Jin B, Luo Y, Teng Z, Dong Y, Wen F, An Y, Yuan C, Chen T, Zhou L, Chen Y, Zhang J, Wang Z, Qu J, Jin F, Zhang J, Jin X, Xie X, Wang J, Man L, Fu L, Liu Y. Efficacy of Thalidomide in Preventing Delayed Nausea and Vomiting Induced by Highly Emetogenic Chemotherapy: A Randomized, Multicenter, Double-Blind, Placebo-Controlled Phase III Trial (CLOG1302 study). J Clin Oncol 2017; 35:3558-3565. [PMID: 28854065 DOI: 10.1200/jco.2017.72.2538] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose We examined the efficacy and safety of thalidomide (THD) for the prevention of delayed nausea and vomiting in patients who received highly emetogenic chemotherapy (HEC). Patients and Methods In a randomized, double-blind, active-controlled, phase III trial, chemotherapy-naive patients with cancer who were scheduled to receive HEC that contained cisplatin or cyclophosphamide-doxorubicin/epirubincin ≥ 50 mg/m2 regimens were randomly assigned to a THD group (100 mg twice daily on days 1 to 5) or placebo group, both with palonosetron (0.25 mg on day 1) and dexamethasone (12 mg on day 1; 8 mg on days 2 to 4). Primary end point was complete response to vomiting—no emesis or use of rescue medication—in the delayed phase (25 to 120 h). Nausea and anorexia on days 1 to 5 were evaluated by the 4-point Likert scale (0, no symptoms; 3, severe). Quality of life was assessed by the European Organization for Research and Treatment of Cancer QLQ-C30 version 3 questionnaire on days −1 and 6. Results Of 656 patients, 638 were evaluable: 317 in the THD group and 321 in the control group. Compared with placebo, delayed and overall (0 to 120 h) complete response rates to vomiting were significantly higher with THD: 76.9% versus 61.7% ( P < .001) and 66.1% versus 53.3% ( P = .001), respectively. Rates of no nausea were also higher in the THD group (delayed: 47.3% v 33.3%; P < .001; overall: 41% v 29.6%; P = .003), and mean scores of anorexia were lower overall (0.44 ± 0.717 v 0.64 ± 0.844; P = .003). Adverse effects were mild to moderate. The THD group had increased sedation, dizziness, constipation, and dry mouth, but experienced better quality of life after chemotherapy. Conclusion Thalidomide combined with palonosetron and dexamethasone significantly improved HEC-induced delayed nausea and vomiting prevention in chemotherapy-naive patients.
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Affiliation(s)
- Lingyun Zhang
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Xiujuan Qu
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Yuee Teng
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Jing Shi
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Ping Yu
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Tao Sun
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Jingyan Wang
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Zhitu Zhu
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Xiuna Zhang
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Mingfang Zhao
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Jing Liu
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Bo Jin
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Ying Luo
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Zan Teng
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Yuyang Dong
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Fugang Wen
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Yuzhi An
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Caijun Yuan
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Tiejun Chen
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Lizhong Zhou
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Ying Chen
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Jian Zhang
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Zhenghua Wang
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Jinglei Qu
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Feng Jin
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Jingdong Zhang
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Xiuhua Jin
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Xiaodong Xie
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Jun Wang
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Li Man
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Lingyu Fu
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
| | - Yunpeng Liu
- Lingyun Zhang, Xiujuan Qu, Yuee Teng, Jing Shi, Ping Yu, Mingfang Zhao, Jing Liu, Bo Jin, Ying Luo, Zan Teng, Ying Chen, Jinglei Qu, Feng Jin, Lingyu Fu, and Yunpeng Liu, First Hospital of China Medical University, Shenyang; Tao Sun and Jingdong Zhang, Cancer Hospital of China Medical University; Xiaodong Xie, General Hospital of Shenyang Military Region, Shenyang; Jingyan Wang, Liaoyang Petrochemical General Hospital; Jian Zhang, Liaoyang Central Hospital; Jun Wang, The Third People’s Hospital of
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Olanzapine for prevention of chemotherapy-induced nausea and vomiting in children and adolescents: a multi-center, feasibility study. Support Care Cancer 2017; 26:549-555. [DOI: 10.1007/s00520-017-3864-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 08/21/2017] [Indexed: 10/19/2022]
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Rashad N, Abdel-Rahman O. Differential clinical pharmacology of rolapitant in delayed chemotherapy-induced nausea and vomiting (CINV). Drug Des Devel Ther 2017; 11:947-954. [PMID: 28392676 PMCID: PMC5373840 DOI: 10.2147/dddt.s108872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Rolapitant is a highly selective neurokinin-1 receptor antagonist, orally administered for a single dose of 180 mg before chemotherapy with granisetron D1, dexamethasone 8 mg BID on day 2-4. It has a unique pharmacological characteristic of a long plasma half-life (between 163 and 183 hours); this long half-life makes a single use sufficient to cover the delayed emesis risk period. No major drug-drug interactions between rolapitant and dexamethasone or other cytochrome P450 inducers or inhibitors were observed. The clinical efficacy of rolapitant was studied in two phase III trials in highly emetogenic chemotherapy and in one clinical trial in moderately emetogenic chemotherapy. The primary endpoint was the proportion of patients achieving a complete response (defined as no emesis or use of rescue medication) in the delayed phase (>24-120 hours after chemotherapy). In comparison to granisetron (10 μg/kg intravenously) and dexamethasone (20 mg orally) on day 1, and dexamethasone (8 mg orally) twice daily on days 2-4 and placebo, rolapitant showed superior efficacy in the control of delayed and overall emesis. This review aims at revising the pharmacological characteristics of rolapitant, offering an updated review of the available clinical efficacy and safety data of rolapitant in different clinical settings, highlighting the place of rolapitant in the management of chemotherapy-induced nausea and vomiting (CINV) among currently available guidelines, and exploring the future directions of CINV management.
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Affiliation(s)
- Noha Rashad
- Medical Oncology Department, Maadi Armed Forces Hospital
| | - Omar Abdel-Rahman
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Chelkeba L, Gidey K, Mamo A, Yohannes B, Matso T, Melaku T. Olanzapine for chemotherapy-induced nausea and vomiting: systematic review and meta-analysis. Pharm Pract (Granada) 2017; 15:877. [PMID: 28503222 PMCID: PMC5386623 DOI: 10.18549/pharmpract.2017.01.877] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/07/2017] [Indexed: 11/29/2022] Open
Abstract
Background: Chemotherapy induced nausea and vomiting (CINV) remains the most distressing event in patients receiving highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC). Objective: Therefore, this meta-analysis was conducted to evaluate the efficacy of olanzapine containing regimen in preventing acute, delayed and overall phases of CINV. Methods: PubMed, EBSCO, and Cochrane central register of controlled trials electronic databases were searched to identify RCTs that compared the effects of olanzapine with non-olanzapine regimen in preventing CINV. Randomized clinical trials (RCTs) that compared olanzapine containing regimen with non-olanzapine regimen were included. The primary outcomes were the percentage of patients achieving no vomiting or no nausea in acute, delayed and overall phases. Results: 13 RCTs that enrolled 1686 participants were included in this meta-analysis. 852 patients were assigned to olanzapine and 834 patients were assigned to non-olanzapine regimen (other standard antiemetic regimen). The percentages of no emesis achieved were 87.5%, 76.2%, 73.6% in olanzapine versus 76.7%, 61.8%, and 56.4% in non-olanzapine regimen in acute, delayed and overall phases, respectively. The percentages of no nausea were 82%, 64.3%, 61.6% in olanzapine group versus 71.3%, 41.8%, and 40.6% in non-olanzapine group in acute, delayed and overall phases, respectively. In general, olanzapine containing regimen achieved statistical superiority to non-olanzapine regimen in no vomiting endpoint in acute phase (OR 2.16; 95%CI 1.60 to 2.91, p<0.00001; I-square=5%; p=0.40), delayed phase (OR 2.28; 95%CI 1.1.46 to 3.54, p=0.0003; I-square=65%; p=0.001) and overall phase (OR 2.48; 95%CI 1.59 to 3.86, p<0.0001; I-square=69%; p< 0.0001). Conclusion: The current meta-analysis showed that olanzapine was statistically and clinically superior to non-olanzapine regimen in preventing CINV in most domains of the parameters.
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Affiliation(s)
- Legese Chelkeba
- PhD. Department of clinical Pharmacy, College of Health Sciences, Jimma University. Jimma, (Ethiopia).
| | - Kidu Gidey
- MSc. Department of clinical Pharmacy, College of Health Sciences, Jimma University. Jimma, (Ethiopia).
| | - Ayele Mamo
- MSc. Department of clinical Pharmacy, College of Health Sciences, Jimma University. Jimma, (Ethiopia).
| | - Berhane Yohannes
- MSc. Department of clinical Pharmacy, College of Health Sciences, Jimma University. Jimma, (Ethiopia).
| | - Tsehay Matso
- MSc. Department of clinical Pharmacy, College of Health Sciences, Jimma University. Jimma, (Ethiopia).
| | - Tsegaye Melaku
- MSc. Department of clinical Pharmacy, College of Health Sciences, Jimma University. Jimma, (Ethiopia).
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Yoodee J, Permsuwan U, Nimworapan M. Efficacy and safety of olanzapine for the prevention of chemotherapy-induced nausea and vomiting: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2017; 112:113-125. [PMID: 28325253 DOI: 10.1016/j.critrevonc.2017.02.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/08/2017] [Accepted: 02/14/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Olanzapine is an anti-psychotic drug that has been used for preventing and treating Chemotherapy-Induced Nausea and Vomiting (CINV). This study aimed to systematically review and meta-analyze the efficacy and safety of olanzapine for prophylaxis and treatment of CINV. METHODS We conducted a systematic literature search of MEDLINE, EMBASE, SCOPUS, and the Cochrane Central Register of Controlled Trials-CENTRAL up to July 15, 2016. All observational and intervention studies were included, but only the intervention studies were pooled for meta-analysis. The efficacy outcome was the proportion of patients achieving complete response (CR) - no emesis and no rescue therapy, in the acute, delayed, and overall phases. The safety outcomes were the adverse events associated with olanzapine according to Common Terminology Criteria for Adverse Events (CTCAE). RESULTS Sixteen studies were eligible: 15 clinical trials and 1 observational study. Nine of the interventional studies were pooled for meta-analysis. The CR of olanzapine was superior to other anti-emetic regimens, in both the delayed and overall phases (RR=1.27, 95% CI 1.07-1.49, RR=1.32, 95% CI 1.08-1.62, respectively). However, olanzapine was not better than standard CINV prophylaxis of the nausea and emesis outcome in the acute phase. Drowsiness and constipation were the most reported adverse events. No grade 3 or 4 adverse events were reported. CONCLUSION Olanzapine is effective and safe at reducing during the delayed and overall phase of the CINV prevention. Other regimens might be added, in cases of CINV during the acute phase of CINV.
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Affiliation(s)
- Jukapun Yoodee
- Faculty of Pharmacy, Chiang Mai University,Suthep Road, Muang District, Chiang Mai, 50200, Thailand
| | - Unchalee Permsuwan
- Faculty of Pharmacy, Chiang Mai University,Suthep Road, Muang District, Chiang Mai, 50200, Thailand
| | - Mantiwee Nimworapan
- Faculty of Pharmacy, Chiang Mai University,Suthep Road, Muang District, Chiang Mai, 50200, Thailand.
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Abstract
OPINION STATEMENT Nausea and vomiting result from continuous interactions among gastrointestinal, central nervous system, and autonomic nervous system. Despite being closely associated, central pathways of nausea and vomiting appear to be at least partly different and nausea is no longer considered only a penultimate step of vomiting. Although our understanding of central pathways of nausea has improved over the last one decade, it is still very basic. Afferent pathways from gastrointestinal tract via vagus, vestibular system, and chemoreceptor trigger zone project to nucleus tractus solitarius which, in turn, relays the signal to central pattern generator initiating multiple downstream pathways. This central nausea pathway appears to be under constant modulation by autonomic nervous system and cerebral cortex. There is also some evidence that central pathway of chronic nausea is different from that of acute nausea and closely resembles that of neuropathic pain. This improved understanding has modified the way we can approach the treatment of acute and chronic nausea. While conventional therapies such as antiemetics (antiserotoninergic, antihistaminic, antidopaminergic) and prokinetics are commonly used to manage acute nausea, they are not as effective in improving chronic nausea. Recently, neuromodulators such as tricyclic antidepressants, gabapentin, olanzapine, benzodiazepines, and cannabinoids have been shown to have antinausea effect. There is a need to study the utility of these drugs in managing chronic functional nausea. Improving our understanding of central and peripheral circuitry of nausea will allow us to better utilize the currently available drugs and develop new therapeutic options.
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Affiliation(s)
- Prashant Singh
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, 02115, USA
| | - Braden Kuo
- Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, GI Unit 55 Fruit St., Blake 4, Boston, MA, 02114, USA.
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An Overview of Radiation-Induced Nausea and Vomiting. J Med Imaging Radiat Sci 2016; 47:S29-S38. [PMID: 31047484 DOI: 10.1016/j.jmir.2016.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 06/24/2016] [Accepted: 06/29/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Radiation-induced nausea and vomiting (RINV) is common occurrence in cancer patients treated with radiotherapy. When radiation is prescribed to certain sites, it can lead to retching, vomiting, and nausea that can lead to impairments on quality of life and even effect adherence to treatment regimes. The present study reports select literature examining RINV phenomena and reviews mechanisms of RINV as well as current management strategies. METHODS A literature search was conducted on PubMed using search strategies such as "radiation-induced nausea vomiting," "RINV," and "radiation and antiemetics." The search was limited to articles published from January 2000 to April 2016 and those that involved humans and were published in English. Information regarding emetic risk of each treatment and management strategies used were extracted from each article. RESULTS A total of 25 articles were included in this select review. The current evidence regarding the standard antiemetics for RIINV are discussed, as well as upcoming therapies and future potential endeavors. CONCLUSIONS Cancer patients treated with emetogenic radiotherapy are at risk of experiencing RINV. RINV has the potential to impact patient quality of life and treatment delivery and optimal prophylactic strategies should be implemented, particularly in radiation naïve patients. More awareness on these topics is warranted, so that standard antiemetic regimens can be used in both the prophylactic and rescue settings.
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