Evaluation of Olanzapine for the Prevention of Refractory Chemotherapy-Induced Vomiting in Pediatric Oncology Patients.

Abstract

Objective: The use of olanzapine for control of chemotherapy-induced vomiting (CIV) has increased; however, data on safety and efficacy in pediatric patients are limited. The primary objective of this study is to assess olanzapine for the prevention of refractory CIV in pediatric oncology patients.

Methods: This study is a retrospective, cross-control study of patients admitted to a pediatric hematology oncology service. Complete control of CIV was defined as no documented emesis and no administration of rescue antiemetics. For inclusion, patients had to have 1 encounter without and 1 encounter with olanzapine. Exclusion criteria included olanzapine use outside of CINV indication or olanzapine administration occurring after the start of chemotherapy.

Results: A total of 26 patients were included, with a median age of 14 years (IQR, 11.74-15.26) and median baseline weight of 56.2 kg (53.35-68.83). The median olanzapine dose administered was 0.089 mg/kg/dose. Olanzapine administration resulted in a higher number of patients achieving complete control of CIV (30.7% vs 11.5%; p = 0.001), reduction in doses of rescue antiemetic agents administered (1 vs 3 doses; p = 0.0117), but increase in documented somnolence by nurse assessment in patients receiving olanzapine (15.4% vs 7.7%; p < 0.001).

Conclusion: The addition of olanzapine appears effective at achieving complete control of CIV when used for the prevention of refractory CIV.