The use of olanzapine versus metoclopramide for the treatment of breakthrough chemotherapy-induced nausea and vomiting (CINV) in patients receiving highly emetogenic chemotherapy

SUMMARY: Breakthrough Chemotherapy Induced Nausea and Vomiting (CINV) is encountered in 30-40% of patients, in spite of treatment with prophylactic antiemetics. ZYPREXA® (Olanzapine) is a FDA approved antipsychotic agent. In this double blind, randomized, phase III trial, chemotherapy naïve patients receiving highly emetogenic chemotherapy who had experienced breakthrough CINV were randomized to receive either ZYPREXA® 10 mg orally daily for three days or REGLAN® (Metoclopramide) 10mg orally TID for three days. They were then monitored for 72 hours. During this 72 hour observation period, 71% patients receiving ZYPREXA® had no emesis compared to 32% in the group receiving REGLAN® (P<0.01). With regards to nausea, 67% of patients in the ZYPREXA® group did not experience nausea, compared to 24% in the REGLAN® group (P<0.01). This new treatment option with ZYPREXA®  may help a significant number of patients who experience breakthrough CINV. Navari RM, Nagy CK, Gray SE. J Clin Oncol. 2012; 30 (suppl; abstr 9064).