Olanzapine may help control nausea, vomiting in patients with advanced cancer

Charles Loprinzi, M.D., a Mayo Clinic medical oncologist, played a leadership role in this work in conjunction with Rudolph Navari, M.D., of The University of Alabama at Birmingham.

"It's well-appreciated by most people that patients receiving cancer chemotherapy suffer from nausea and vomiting," explains Dr. Loprinzi. "However, it's less well-appreciated that patients with advanced cancer also have significant problems with nausea and vomiting that are unrelated to chemotherapy."

Drs. Loprinzi and Navari found limited research regarding nausea and vomiting in patients with advanced cancer unrelated to chemotherapy, so they decided to conduct a clinical trial.

The colleagues, along with other collaborators, conducted a randomized, placebo-controlled trial in 30 patients with advanced cancer who had not recently received chemotherapy or radiation therapy but did have substantial trouble with nausea and vomiting. Researchers randomly assigned patients to receive a low-dose of olanzapine or a placebo daily. Neither the trial participants nor their clinicians knew whether participants were receiving olanzapine or a placebo.

Prior to starting their medications on the first day of the study, participants rated their nausea over the previous 24 hours on a scale of 0-10, with 0 being none and 10 being as bad as it could be. Participants continued to rate their nausea every day at about the same time of day for the duration of the study.

When the study was unblinded, the research team learned that all 30 participants recorded nausea scores of 8-10 on the first day of the study. After one day and one week, nausea scores in the 15 patients who received a placebo were all still 8-10 out of 10. In contrast, the 15 patients who received olanzapine had scores of 2-3 out of 10 after one day and 0-3 out of 10 after one week. Correspondingly, these patients reported less vomiting, better appetite and better well-being. No patient-reported adverse events were observed among trial participants receiving olanzapine.

"Olanzapine given at 5 milligrams per day for seven days markedly improved patient quality of life with no side effects," says Dr. Navari. "And as a generic drug, it's also relatively affordable, with a one-month supply often costing anywhere from $10 to $15."

"Current guidelines for the management of nausea and vomiting in patients with advanced cancer have not specifically indicated that one drug looks substantially better than a variety of other drugs," says Dr. Loprinzi. "However, we believe the present results may be viewed as a best practice for treating nausea and vomiting in patients with advanced cancer-associated nausea and vomiting."