Vol 10, Issue 11, 2017 Online - 2455-3891 Print - 0974-2441 OLANZAPINE COMBINED WITH STANDARD ANTIEMETIC REGIMENS FOR PREVENTION OF CHEMOTHERAPY THERAPY-INDUCED NAUSEA AND VOMITING: A SINGLE-CENTER EXPERIENCE FROM SOUTH INDIA EMMANUEL JAMES 1 *, DRISYA PM 1 , WESLEY M JOSE 2 1 Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Amrita University, AIMS Health Science Campus, Kochi - 682 041, Kerala, India. 2 Department of Medical Oncology & Hematology, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Amrita University, AIMS Health Science Campus, Kochi, Kerala, India. Email: emmanuelj@aims.amrita.edu Received: 03 April 2017, Revised and Accepted: 28 July 2017 ABSTRACT Objectives: Olanzapine, an antipsychotic agent, exhibits significant antiemetic properties due to its inhibitory activity on neurotransmitters at multiple receptors involved in chemotherapy-induced nausea and vomiting (CINV). CINV can have an immensely negative impact on patient’s quality of life (QOL) and daily activities. Our objectives were to determine the effectiveness of adding olanzapine to standard antiemetic regimens for the prevention of CINV in cancer patients and to compare the QOL of such patients with those receiving standard antiemetic regimens. Methods: A prospective, observational, cohort study was done on patients receiving either highly or moderately emetogenic chemotherapy (MEC). The patients who received only the standard antiemetic regimens were considered as the control group and those who received 10 mg of olanzapine once daily on days 1-5 of chemotherapy in addition to the standard antiemetic regimens were considered to be the study group. The patients were assessed for grades of nausea and vomiting using National Cancer Institute common terminology criteria for adverse events and for QOL using European Organization in Research and Treatment of Cancer QOL questionnaire. Results: Patients were evaluated for a total of 168 cycles of chemotherapy. Compared to the control group, the study group patients showed significant improvement in response to acute nausea (p=0.02) but not in acute vomiting (p=0.09). However, response to delayed nausea and vomiting improved significantly (p=0.004 and p=0.05, respectively). The QOL of study group patients showed significant improvement in functional scales and symptom scales (p<0.02). Global health status also increased significantly (p=0.02) in the study group patients. Conclusion: Olanzapine containing pre-medication regimens can reduce acute and delayed nausea and delayed vomiting and improve the QOL of cancer patients receiving highly or moderately emetogenic chemotherapeutic agents as compared to the standard pre-medication regimens. Keywords: Adverse events, Chemotherapy-induced nausea and vomiting, Effectiveness, Olanzapine, Quality of life. INTRODUCTION Chemotherapy-induced nausea and vomiting (CINV) are severe distressing adverse effects experienced by cancer patients receiving chemotherapy. Nausea and vomiting associated with cancer chemotherapy is distinct from typical nausea and vomiting that many people experience in their normal daily life. CINV can have an immensely negative impact on the patients’ quality of life (QOL) and daily activities [1-5]. It can have a number of clinical implications for patients, including non-compliance with treatment, unwillingness or inability to eat and/or drink, and nutritional deficits. In most of the cases, sufferings experienced by cancer patients have been related to QOL to a great extent, and hence measurement of QOL can be used as an outcome measure to compare the effectiveness of different antiemetic treatment regimens [6,7]. The goal of antiemetic therapy is to reduce or negate nausea and vomiting associated with chemotherapy. A number of antiemetic regimens exist but are not fully effective. The most commonly used antiemetics such as 5-hydroxytryptamine-3 (5HT 3 ) antagonists, dexamethasone, or neurokinin-1 receptor antagonists prevent emesis only in 60-70% of cancer patients receiving highly emetogenic chemotherapy (HEC) [8,9]. Hence, new drugs and regimens are being explored for more effective control of nausea and vomiting. Olanzapine in lieu of its inhibitory activity on neurotransmitters at multiple receptors involved in CINV, especially at D2 and 5-HT3 receptors, may exhibit significant antiemetic properties [10-12]. Hence, addition of olanzapine to standard antiemetic regimens may improve control of nausea and vomiting in cancer patients receiving highly or moderately emetogenic chemotherapeutic agents. As a result of the reduction in nausea and vomiting, the QOL of the patients may improve [7]. Improved QOL during chemotherapy is bound to increase the confidence of the patients, improve compliance to treatment, and ultimately result in better clinical efficacy. Often, the cancer patients have some symptoms of depression and anxiety, and olanzapine can also exert an antidepressant effect in these patients [13,14]. Although there are studies [15-20] describing the use of olanzapine for prevention of CINV, there is scarcity of data on Indian patients. Hence, our study was undertaken to compare the effectiveness of olanzapine containing antiemetic regimens with standard regimens for the prevention of CINV and to compare the QOL of patients between the two groups. METHODS A prospective observational study was carried out on cancer patients receiving highly or moderately emetogenic chemotherapy at the Department of Medical Oncology and Hematology of Amrita Institute of Medical Sciences and Research Centre, Kochi, India, from October 2013 to June 2014. This study was approved by the Institutional Review Board, and informed signed consent was obtained from all the study © 2017 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4. 0/) DOI: http://dx.doi.org/10.22159/ajpcr.2017.v10i11.18864 Research Article