Olanzapine, typically used for psychiatric conditions, has demonstrated effectiveness in controlling severe nausea in breast cancer patients undergoing chemotherapy. This finding was presented at the American Society of Clinical Oncology (ASCO) Quality Care Symposium. Separately, a study in the Journal of Clinical Oncology found that adding a cannabis extract to standard treatment alleviated chemotherapy-induced nausea and vomiting.
Olanzapine Reduces Nausea in Breast Cancer Patients
In a Phase III trial (NCT03367572), researchers evaluated olanzapine (Zyprexa) against prochlorperazine (Compazine) for managing chemotherapy-induced nausea. The study involved over 1,300 women with breast cancer who experienced at least moderate nausea despite receiving standard antiemetic drugs during their first chemotherapy cycle. Participants were randomized to receive either olanzapine, prochlorperazine, or a placebo in addition to standard antiemetics during their subsequent cycle.
The results indicated that both olanzapine and prochlorperazine significantly reduced nausea, with olanzapine proving more effective for patients with severe nausea. Olanzapine recipients experienced a 2.6-point decrease in their maximum nausea score, compared to a 2.0-point decline for prochlorperazine recipients. Additionally, the olanzapine group reported a significant improvement in their overall quality of life compared to the placebo group.
According to Luke Peppone, PhD, of the University of Rochester Medical Center, these findings highlight olanzapine's potential to provide more effective relief for patients suffering from severe nausea despite standard antiemetic treatments. This could make chemotherapy more tolerable, contributing to better overall outcomes and patient satisfaction.
Cannabis Extract Alleviates Refractory Nausea and Vomiting
Another study investigated the efficacy of an oral cannabis extract in adults experiencing refractory nausea or vomiting during IV chemotherapy, despite using guideline-consistent antiemetic prophylaxis. The Phase II/III trial enrolled 147 evaluable patients between 2016 and 2022.
Participants were randomly assigned to receive oral capsules containing 2.5 milligrams each of tetrahydrocannabinol (THC) and cannabidiol (CBD) or placebo capsules three times daily on days 1 to 5 of their first chemotherapy cycle. They then crossed over to the opposite assignment for the second cycle and chose their preferred regimen for the third cycle.
The study found that participants receiving THC/CBD capsules were three times more likely to experience a complete response, defined as no vomiting or retching and no use of rescue medications, after the first chemotherapy cycle (24% versus 8% for placebo). The cannabis extract group also reported no significant nausea more frequently (20% versus 7%), had fewer daily vomiting episodes (0.2 versus 0.5), and had higher scores on a nausea quality-of-life questionnaire.
While no serious adverse events were attributed to the cannabis extract, THC/CBD recipients reported more frequent bothersome side effects, including sedation (18% versus 7%), dizziness (10% versus 0%), and temporary anxiety (4% versus 1%).
The study authors concluded that THC/CBD is an effective adjunct for chemotherapy-induced nausea and vomiting despite standard antiemetic prophylaxis, but noted the association with additional adverse events. They also highlighted that drug availability, cultural attitudes, legal status, and preferences may affect implementation.
