523PD - Assessing the effectiveness of olanzapine for the prevention of chemotherapy-induced nausea and vomiting (CINV) in patients who fail therapy with a...

Date 18 December 2016
Event ESMO Asia 2016 Congress
Session Supportive and palliative care
Topics Cytotoxic agents
Complications/Toxicities of treatment
Supportive measures
Presenter Nikita Mehra
Citation Annals of Oncology (2016) 27 (suppl_9): ix170-ix176. 10.1093/annonc/mdw599
Authors N.J. Mehra1, P. Ganesan2, A. Boopathy3
  • 1Medical Oncology, Cancer Institute ( WIA ), 600036 - Chennai/IN
  • 2Medical Oncology, Cancer Institute ( WIA ), 600020 - Chennai/IN
  • 3Psycho Oncology, Cancer Institute ( WIA ), 600020 - Chennai/IN

Abstract

Background

In patients who present with chemotherapy-induced nausea and vomiting (CINV) of grade≥2, despite the use of aprepitant, an alternative is required. Olanzapine has been shown to be equivalent or even superior to aprepitant in controlling CINV in randomized trials. However there is little data on the use of olanzapine in patients who fail aprepitant.

Methods

Patients receiving Highly Emetogenic Chemotherapy (HEC) [cisplatin ≥ 70mg/m2- Single agent or combination, Epirubicin/Adriamycin + Cyclophosphamide combination, Adriamycin ≥60mg/m2- Single agent or combination]and developedh CINV≥2 despite APD (Aprepitant + Palonosetron + Dexamethasone) received OPD (Olanzapine + Palonosetron + Dexamethasone) in the subsequent cycle. Patients were prospectively assessed using FLIE (Functional Living Index-Emesis) and the MDASI (M.D.Anderson Symptom Inventory) questionnaires. The primary end point of complete response (CR) (no emetic episodes and no use of rescue medication) for the overall period (0–120 hours post chemotherapy) was assessed using a validated [PG1] CINV diary. Assessments within the same patient for the cycles of APD and OPD were compared for the above parameters.

Results

180 patients receiving highly emetogenic chemotherapy were screened, of which 45 patients failed APD regimen with grade ≥2 nausea and/or vomiting. They received Olanzapine 10mg from D1-4. The mean age was 43.5 years (18-65), Male:female 1.25:1. The chemotherapy regimens used were: FEC 75/90- 40% (n = 18), AC- 29% (n = 13), EP- 18% (n = 8), IAP- 4% (n = 2), IA- 4% (n = 2), AP- 2% (n = 1) and cisplatin 70mg/m2- 2% (n = 1). Results for the overall period (0-120h): CR (no emesis, no rescue medications)- 69% (31/45) and No nausea- 47% (21/45). 2 patients had grade 3 drowsiness requiring hospitalization.

Conclusions

69% of patients who failed Aprepitant based therapy could be rescued with Olanzapine in the subsequent cycle. The OPD regimen has cost implications for patients in countries with limited insurance. The cost per course of Aprepitant is approximately US$9 while Olanzapine costs approximately US$0.30 per course.

Clinical trial indentification

Not Applicable

Legal entity responsible for the study

Cancer Institute WIA

Funding

Cancer Institute WIA

Disclosure

All authors have declared no conflicts of interest.