Olanzapine may be better than prochlorperazine for reducing refractory nausea in patients with breast cancer starting a high/moderate emetogenic chemotherapy regimen, according to a study presented at the American Society of Clinical Oncology annual Quality Care Symposium, held from Sept. 27 to 28 in San Francisco.
Luke Joseph Peppone, Ph.D., from the University of Rochester Medical Center in New York, and colleagues randomly assigned 310 chemotherapy-naive patients with breast cancer starting a high/moderate emetogenic chemotherapy regimen with moderate or worse nausea (≥3 on a 1-to-7 scale) in cycle 1 to olanzapine, prochlorperazine, or placebo.
The researchers found a statistically significant change in average nausea score for the olanzapine (average change, −1.07: Cohen’s Δ = 0.49) and prochlorperazine groups (average change, −0.94: Cohen’s Δ = 0.38) versus the placebo group (average change, −0.50). For change in maximum nausea score, similar but larger changes were seen in the olanzapine (maximum change, −2.57: Cohen’s Δ = 0.86) and prochlorperazine arms (maximum change, −2.01: Cohen’s Δ = 0.47) versus the placebo arm (maximum change, −1.30).
From before chemo to cycle 2, the olanzapine group had a clinically significant change in overall quality of life compared with the placebo group (Functional Assessment of Cancer Therapy-General [FACT-G] mean difference, +4.91). However, the prochlorperazine arm did not have significant improvement versus placebo (FACT-G mean difference, −0.87). Olanzapine showed superiority versus prochlorperazine for changes in maximum nausea score (mean difference, −0.56) and quality of life (FACT-G mean difference, +5.80), but not for average nausea (mean difference, −0.13).
“This study fills the gap in empirical comparisons and solidifies olanzapine’s position as a promising intervention for refractory nausea,” the authors write.
Several authors disclosed ties to the pharmaceutical industry.
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Olanzapine, prochlorperazine both alleviate refractory chemo-related nausea (2024, October 2)
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