Antiemetic Efficacy of Adding Olanzapine 5 mg to Aprepitant, Palonosetron and Dexamethasone-Sparing After Day Two for Cancer Patients Receiving Anthracycline and Cyclophosphamide
Received 18 September 2020
Accepted for publication 15 December 2020
Published 17 February 2021 Volume 2021:13 Pages 1617—1624
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Seema Singh
Marii Suehiro,1,* Yasuyuki Kojima,2,* Masaki Takahashi,3,* Yuka Ito,4 Takayuki Keira,1 Kiwako Ikegawa,1 Hiroko Minatogawa,1 Koichiro Tsugawa,2 Tsuneaki Tanaka1
1Department of Pharmacy, St. Marianna University School of Medicine Hospital, Kawasaki-shi, Kanagawa, 216-8511, Japan; 2Division of Breast and Endocrine Surgery, Department of Surgery, St. Marianna University School of Medicine Hospital, Kawasaki-shi, Kanagawa, 216-8511, Japan; 3Division of Medical Informatics, St. Marianna University School of Medicine Hospital, Kawasaki-shi, Kanagawa, 216-8511, Japan; 4Department of Pharmacy, Kawasaki Municipal Tama Hospital, Kawasak-shi, Kanagawa, 214-8525, Japan
*These authors contributed equally to this work
Correspondence: Marii Suehiro
Department of Pharmacy, St. Marianna University School of Medicine Hospital, 2-16-1 Sugao, Miyamae-Ku, Kawasaki-shi, Kanagawa, 216-8511, Japan
Purpose: Chemotherapy-induced nausea and vomiting (CINV) decrease patient quality of life (QOL). We evaluated the efficacy of adding 5 mg Olz to a three-drug steroid-sparing antiemetic regimen (aprepitant, palonosetron, and dexamethasone-sparing after day two) for breast cancer (BC) patients receiving anthracycline plus cyclophosphamide (AC) chemotherapy.
Patients and Methods: We retrospectively reviewed the records of 177 BC patients with no previous highly emetogenic chemotherapy history receiving AC plus the steroid-sparing three-drug regimen or the steroid-sparing four-drug regimen including Olz 5mg at our hospital between January 2012 and December 2018. The primary endpoint was complete response (CR), defined as no vomiting and no usage of rescue medication during the first AC cycle. We analyzed the odds ratio (OR) of the CR with 95% confidence interval (CI) in the three-drug group against the four-drug group. The OR was adjusted for types of anticancer drugs by the Cochran–Mantel–Haenszel (CMH) test. Secondary endpoints were incidences of nausea, anorexia, fatigue, and somnolence during the first cycle.
Results: Compared to the three-drug group, the four-drug group demonstrated high incidence of no vomiting (71% vs 95%), a similar incidence of no rescue medication usage (50% vs 51%), and a similar CR rate (45% vs 49%). The OR of the CR rate in the three-drug group against the four-drug group after CMH adjustment for drug type was 0.958 (95% CI, 0.46– 1.98). Compared to the three-drug group, the four-drug group demonstrated identical incidence of nausea (66%), but lower incidences of anorexia (78% vs 35%) and fatigue (86% vs 73%). The incidence of somnolence in the four-drug group was 49%. We did not have data of somnolence for the three-drug group in the records.
Conclusion: Adding 5 mg Olz to the steroid-sparing three-drug combination can reduce vomiting, anorexia, and fatigue, although there was no difference in CR rate.
Keywords: breast cancer, highly emetogenic chemotherapy, chemotherapy induced nausea and vomiting, antiemetics
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