Effect of Olanzapine and Ondansetron for Prevention of Platinum based Chemotherapy-Induced Nausea and Vomiting: An Open Label, Randomized Controlled Study

Platinum-based chemotherapy is a cornerstone in the treatment of various malignancies but is often complicated by chemotherapy-induced nausea and vomiting (CINV). CINV can severely affect patients’ adherence to cancer therapy and diminish their quality of life, especially as conventional antiemetic regimens may not completely prevent these distressing symptoms. Both acute (within 24 hours) and delayed (after 24 hours) phases of nausea and vomiting present significant management challenges, particularly in patients receiving highly emetogenic agents like cisplatin.

Olanzapine, primarily an atypical antipsychotic, has gained attention for its potent antiemetic effects due to its blockade of multiple neurotransmitter receptors involved in nausea pathways—including dopaminergic, serotonergic, adrenergic, and histaminic receptors. Its broad pharmacological profile makes it a candidate for both acute and delayed CINV, either alone or as an adjunct to standard therapy. The drug’s use at a lower dose (5mg) is being actively explored, aiming to maximize benefit while minimizing risk of sedation and other side effects.

This open-label, randomized controlled trial conducted at R.L. Jalappa Hospital and Research Centre enrolled 116 adult patients undergoing platinum-based chemotherapy. Participants were randomized to two groups: one received olanzapine in addition to standard antiemetics (dexamethasone and ondansetron), while the control group continued with standard antiemetics alone. Efficacy was measured using validated questionnaires to assess the presence and severity of nausea and vomiting in both the acute and delayed phases across 3–6 chemotherapy cycles. Adverse effects of the study drugs were systematically tracked using established causality and probability scales.