Olanzapine for the Control of Cisplatin-Induced Nausea and Vomiting: A Prospective Randomized Study

Chemotherapy-induced nausea and vomiting (CINV) is still a significant problem in patients receiving highly emetogenic cisplatin-based chemotherapy, and the currently available doublet antiemetic regimens do not provide adequate control. The purpose of this study was to assess if adding low-dose olanzapine (5mg) to the standard granisetron-dexamethasone doublet could improve CINV and quality of life of patients compared to the doublet alone. This prospective, open-label, randomized controlled study with sixty eligible adult patients receiving cisplatin or cisplatin-based combination chemotherapy were randomized into two groups: a treatment group (n = 26) receiving olanzapine 5 mg orally plus IV granisetron 1 mg and dexamethasone 12 mg, and a control group (n = 34) receiving granisetron and dexamethasone alone. Between-group comparisons were performed using Mann-Whitney test. The treatment group demonstrated significantly better CINV control. Mean vomiting grade was 0.15 ± 0.555 vs 1.65 ± 0.996 (p < 0.001), and mean nausea grade was 0.54 ± 0.660 vs 2.18 ± 0.728 (p < 0.001). Quality of life was markedly better in the treatment group, with a mean Functional Living Index–Emesis (FLIE) score of 105.23 ± 5.73 vs 68.06 ± 11.28 in controls (p < 0.001). No adverse effects attributable to olanzapine were reported. Addition of low dose olanzapine (5mg) to granisetron and dexamethasone significantly enhancement of CINV control and quality of life in patients undergoing cisplatin-based chemotherapy with excellent tolerability. These findings support its consideration as a standard antiemetic adjunct, pending confirmation through larger double-blind, placebo-controlled trials.