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Efficacy of Olanzapine-Triple Antiemetic Regimen in Patients with Gastrointestinal Tumor and High Risk of Chemotherapy-Induced Nausea and Vomiting Receiving Moderately Emetogenic Chemotherapy: A Retrospective Study

Authors Wu X, Wu J, Tong G, Cheng B, Chen M, Yu S, He L, Li Z, Wang S

Received 18 March 2020

Accepted for publication 13 July 2020

Published 29 July 2020 Volume 2020:12 Pages 6575—6583


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Lu-Zhe Sun

Xuan Wu,1– 3,* Jingxun Wu,4,* Gangling Tong,1– 3,* Boran Cheng,1– 3,* Minhua Chen,5,* Shaokang Yu,1– 3 Lirui He,6 Zhu Li,1– 3 Shubin Wang1– 3

1Department of Oncology, Peking University Shenzhen Hospital, Shenzhen 518036, People’s Republic of China; 2Shenzhen Key Laboratory of Gastrointestinal Cancer Translational Research, Shenzhen 518036, People’s Republic of China; 3Cancer Institute of Shenzhen-PKU-HKUST Medical Center, Shenzhen 518036, People’s Republic of China; 4Department of Medical Oncology, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People’s Republic of China; 5Community Healthcare Center, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518033, People’s Republic of China; 6Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Shubin Wang Department of Medical Oncology
Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen 518036, People’s Republic of China
Tel +86 75683923333
Fax +86 75683061340

Purpose: Dexamethasone combined with 5-hydroxytryptamine type 3 receptor antagonists (5-HT3 RA) dual regimen is the standard prophylaxis regimen for patients receiving moderately emetogenic chemotherapy (MEC). However, it has been found in real-world practice that chemotherapy-induced nausea and vomiting (CINV) remains poorly controlled among patients with gastrointestinal tumor, especially in those with high-risk factors for vomiting, such as female, young, and non-alcoholic individuals. Hence, we aimed to evaluate the efficacy of an olanzapine-containing triple regimen in this clinical setting.
Patients and Methods: We retrospectively reviewed the clinical records of gastrointestinal tumor patients who received mFOLFOX6, XELOX, or FOLFIRI chemotherapy at two institutions. All patients included were female and less than 55 years old, with no history of drinking. The patients were divided into two groups for olanzapine-containing triple therapy (olanzapine, tropisetron, and dexamethasone) and non-olanzapine dual therapy (tropisetron and dexamethasone). The study outcomes were complete response (CR), complete control (CC), nausea control, and quality of life (QoL) by the functional living index-emesis (FLIE) questionnaire.
Results: A total of 93 patients were included in the study (olanzapine: 40; control: 53). The CR rate in the olanzapine group was significantly higher than that in the control group in delayed and overall phase (75.0% vs 54.7%, p=0.044; 70.0% vs 47.2%; p=0.028). The CC rate in the overall phase was also better in the olanzapine group (62.5% vs 39.6%, p=0.029). The control of nausea in the overall phase showed a superior trend in the olanzapine group (p=0.059). The olanzapine group exhibited higher FLIE scores, which demonstrated better QoL. More patients in the olanzapine group exhibited somnolence and dizziness. Conversely, the incidence of insomnia and anorexia in the olanzapine group was lower.
Conclusion: This retrospective study indicates that in gastrointestinal tumor patients with high-risk factors for CINV who were receiving MEC, olanzapine-containing triple antiemetic regimen exhibit better efficacy and QoL as compared to non-olanzapine dual regimen. Further randomized studies are required to confirm these results.

Keywords: CINV, MEC, olanzapine, gastrointestinal tumor, high risk of emesis

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