Olanzapine Versus Aprepitant Based Antiemetic Regimen for High Emetic Chemotherapy

Randomized, Placebo-controlled Trial of Olanzapine Versus Aprepitant Plus Ondansetron and Dexamethasone as Antiemetic Prophylaxis in Patients Receiving High Emetic Chemotherapy

Aprepitant and olanzapine have been recommended for emesis prevention from highly emetogenic chemotherapy. We hypothesized that olanzapine may lead to less nausea compared to aprepitant based on previous study. However, data of combination of olanzapine and ondansetron is scarce.

Aprepitant and olanzapine have been recommended for emesis prevention from highly emetogenic chemotherapy. We hypothesized that olanzapine may lead to less nausea compared to aprepitant based on previous study. However, data on efficacy and adverse effects of combination of olanzapine and ondansetron which is only serotonin antagonist in Thai national essential drug list, is scarce. Also, we aims to assess the efficacy of olanzapine dosage of 5 mg which is more commonly used in Thai patients.

Inclusion Criteria:

• pathologically proved of solid malignancy
• receive first cycle of cisplatin >= 50 mg/m2 or cyclophosphamide/doxorubicin

Exclusion Criteria:

• pregnancy
• patients with episode of vomiting within 24 hours before starting chemotherapy
• uncontrolled brain/ CNS metastasis
• gut obstruction
• receive combination of moderate or high emetogenic chemotherapy during Day 2-5
• Known allergy to ondansetron, olanzapine, aprepitant or dexamethasone
• currently receive olanzapine with other indication and plan to continue the drug