A comparative study of Aprepitant and Olanzapine in the prevention of chemotherapy induced nausea and vomiting in carcinoma of breast patients.

ChemotherapyInduced Nausea and Vomiting (CINV) the most common side effect of chemotherapy is associated with a significant deterioration in quality of life  and is perceived by patients as a major adverse effect of treatment.

Chemotherapyis a common modality for treatment of Carcinoma Breast. Regardless of the factthat chemotherapy improves survival, it has its own toxicity and side effectsof which nausea and vomiting being significant can affect patient compliance.To avoid the clinical sequelae of CINV like dehydration, electrolyte imbalance,malnutrition, anorexia, stress and anxiety, it is imperative to provideprophylaxis and treatment for CINV.

The principalneurotransmitters that drive CINV in all forms are serotonin, dopamine,acetylcholine, and substance P. The use of 5-hydroxytryptamine3(5-HT3) receptor antagonist plus dexamethasone has significantly improvedthe control of acute CINV.  Recent studies have demonstratedadditional improvement in the control of acute CINV and delayed CINV with theuse of newer agents: Palonosetron, a second generation 5-HT3 receptorantagonist.  Aprepitant, the first agent available in the drugclass of neurokinin-1 (NK1)-receptor antagonists andOlanzapine, an antipsychotic which is used in the treatment of psychoticsymptom, blocks multiple neurotransmitters in the central nervoussystem.  These newer drugs incorporated in prophylactic regimensfor CINV have resulted in significantly reduced rates of this feared complicationof cytotoxic chemotherapy. A recent randomized trial evidence has suggestedthat Olanzapine may have a role in both the prevention and treatment of CINV.