Olanzapine improves nausea, quality of life more effectively than prochlorperazine
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Key takeaways:
- Olanzapine and prochlorperazine reduced nausea compared with placebo for people with symptoms after chemotherapy.
- Olanzapine significantly improved severe nausea and quality of life compared with prochlorperazine.
Olanzapine reduced severe nausea more effectively than prochlorperazine for patients with refractory symptoms after chemotherapy, according to results of a randomized phase 3 trial.
The findings — presented at ASCO Quality Care Symposium — showed both olanzapine and prochlorperazine significantly reduced nausea vs. placebo, but only olanzapine improved quality-of-life scores.
“These important findings highlight the potential for olanzapine to provide more effective relief for patients who suffer from severe nausea despite standard antiemetic treatments,” researcher Luke Joseph Peppone, PhD, associate professor of surgery in the cancer control program at University of Rochester Medical Center, said in an ASCO press release. “This is valuable evidence for health care providers to help guide treatment strategies.
“For patients, this means there may be a more effective option available to improve their symptoms and overall well-being during chemotherapy,” Peppone added. “This could ultimately make the chemotherapy experience more tolerable and manageable, contributing to better overall outcomes and patient satisfaction.”
Background and methods
Olanzapine and prochlorperazine are used to treat nausea, but they work differently. Olanzapine is designed to target receptors in the brain that cause nausea, whereas prochlorperazine blocks substances in the body that lead to the condition, according to study background.
Researchers compared both agents with placebo in a cohort of patients with breast cancer who were beginning high or moderate emetogenic chemotherapy.
The 1,363 participants received ASCO-recommended anti-nausea treatment during chemotherapy. Of that group, 310 individuals (median age 50.7 years; 80.7% white) reported moderate nausea — defined as a score of 3 or higher on a 7-point scale — and continued to the second part of the trial.
Peppone and colleagues randomly assigned those individuals 1:1:1 to receive ASCO-recommended treatment plus olanzapine, prochlorperazine or placebo.
Researchers evaluated nausea based on diaries study participants kept at home, in which they reported outcomes four times a day over 4 days.
Changes in average and maximum nausea, and FACT-G quality-of-life scores from before chemotherapy to after treatment, served as primary endpoints.
Results and next steps
Overall nausea scores dropped significantly more among patients who received olanzapine (average change in nausea score = 1.07; P < .001) or prochlorperazine (0.94; P = .01) than those assigned placebo (0.5).
Maximum nausea scores also decreased significantly more for participants who received olanzapine (max change = 2.57; P < .001) or prochlorperazine (2.01; P < .01) than those assigned placebo (1.3).
Researchers observed significant improvement in quality-of-life scores in the olanzapine cohort compared with placebo (4.91; P = .006). They observed no significant improvement with prochlorperazine vs. placebo (0.87).
Olanzapine conferred significant improvement for both maximum nausea (P = 0.023) and quality of life (P = .006) compared with prochlorperazine.
Investigators plan to assess how both agents perform based on chemotherapy type. They also are trying to identify biomarkers that could predict nausea severity and who might get it.
“Chemotherapy-induced nausea is a highly prevalent and distressing side effect of chemotherapy, which significantly impairs patients’ quality of life,” ASCO expert Oreofe O. Odejide, MD, MPH, medical oncologist at Dana-Farber Cancer Institute and assistant professor of medicine at Harvard Medical School, said in the press release. “The findings of this study positions olanzapine as a promising intervention for patients with refractory chemotherapy-induced nausea.”
References:
- ASCO. Olanzapine reduces nausea and improves quality of life for patients with cancer during chemotherapy (press release). Available at: https://society.asco.org/about-asco/press-center/news-releases/olanzapine-reduces-nausea-and-improves-quality-life-patients. Published Sept. 23, 2024. Accessed Sept. 26, 2024.
- Peppone LJ, et al. Abstract 185. Presented at: ASCO Quality Care Symposium; Sept. 27-28, 2024; San Francisco.
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Peppone LJ, et al. Abstract 185. Presented at: ASCO Quality Care Symposium; Sept. 27-28, 2024; San Francisco.
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