Olanzapine may help control nausea, vomiting in advanced cancer

Volume 9, Issue 2, June 2020

Summary

Study participants reported improvements in vomiting, appetite and well-being while taking the drug.

Photograph of Charles L. Loprinzi, M.D.

The antipsychotic medication olanzapine might help patients with advanced cancer successfully manage nausea and vomiting unrelated to chemotherapy, according to Mayo Clinic researchers who published their findings in the journal JAMA Oncology.

Charles L. Loprinzi, M.D., a medical oncologist at Mayo Clinic in Rochester, Minnesota, played a leadership role in this research in conjunction with Rudolph Navari, M.D., Ph.D., of the University of Alabama at Birmingham.

"It's well appreciated by most people that cancer patients receiving chemotherapy suffer from nausea and vomiting," Dr. Loprinzi said. "However, it's less well appreciated that patients with advanced cancer also have significant problems with nausea and vomiting that are unrelated to chemotherapy."

Drs. Loprinzi and Navari found that there was only limited research about nausea and vomiting unrelated to chemotherapy in patients with advanced cancer, so they launched a clinical trial of their own. Working with collaborators, the pair conducted a randomized, double-blinded placebo-controlled trial in 30 participants with advanced cancer who had not recently received chemotherapy or radiation therapy but did have substantial trouble with nausea and vomiting. Participants were randomly assigned to receive either a low-dose of olanzapine or a placebo daily.

Before starting their medications on the first day of the study, participants rated their nausea over the previous 24 hours on a scale of 0 to 10, with 0 being no nausea and 10 being as bad as it could be. Participants continued to rate their nausea every day at about the same time of day for the duration of the study.

When the study was unblinded, the research team learned that all 30 participants recorded nausea scores of 8 to 10 on the first day of the study. After eight days, nausea scores for the 15 participants who received a placebo were all still 8 to 10. In contrast, the 15 participants who received olanzapine had scores of 2 to 3 after one day and 0 to 3 after eight days.

"Olanzapine given at 5 milligrams per day for seven days markedly improved patient quality of life with no side effects," Dr. Navari said. "And as a generic drug, it's also relatively affordable, with a one-month supply often costing anywhere from $10 to $15."

"Current guidelines to manage nausea and vomiting in patients with advanced cancer don't indicate that one specific drug is preferred over others," Dr. Loprinzi said. "However, we believe the present results may be viewed as a best practice for treating nausea and vomiting in patients with advanced, cancer-associated nausea and vomiting," he said.

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