Chiu Leonard, Chow Ronald, Popovic Marko, Navari Rudolph M, Shumway Nathan M, Chiu Nicholas, Lam Henry, Milakovic Milica, Pasetka Mark, Vuong Sherlyn, Chow Edward, DeAngelis Carlo
Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
Indiana University School of Medicine, South Bend, IN, USA.
Support Care Cancer. 2016 May;24(5):2381-2392. doi: 10.1007/s00520-016-3075-8. Epub 2016 Jan 15.
Olanzapine is a potent antipsychotic medication that inhibits a wide variety of receptors. It has been used in trials for the prophylaxis and rescue of chemotherapy-induced nausea and vomiting (CINV). This study systematically investigates the efficacy of olanzapine in relation to other antiemetics in the prophylaxis and rescue of CINV.
A literature search of Ovid MEDLINE, EMBASE, and CENTRAL was conducted to identify randomized controlled trials (RCTs) comparing olanzapine to other standard antiemetics for either prevention or rescue. The primary endpoints were the percentage of patients achieving no emesis or no nausea, in the acute, delayed, and overall phases.
Ten RCTs in the preventative setting and three RCTs in the breakthrough setting were identified. Subgroup analysis demonstrated a similar degree of benefit from a 5- and 10-mg dose of olanzapine for the no emesis endpoint in the overall phase. In the prophylaxis setting, olanzapine was statistically superior in five of six endpoints and clinically superior in four of six endpoints. In the breakthrough setting, olanzapine was statistically and clinically superior in the only endpoint analyzed: no emesis.
Olanzapine is more efficacious than other standard antiemetics for the rescue of CINV and its inclusion improves control in the prevention setting. Given the possible reduction in side effects, the use of a 5-mg dose of olanzapine should be considered. Future RCTs should compare the 5-mg versus the 10-mg dosages further and report on the efficacy and percentage of patients developing side effects. Further analyses should be done without the influence of corticosteroids.
奥氮平是一种强效抗精神病药物，可抑制多种受体。它已用于化疗引起的恶心和呕吐（CINV）的预防和解救试验。本研究系统地调查了奥氮平与其他止吐药相比在CINV预防和解救中的疗效。
对Ovid MEDLINE、EMBASE和CENTRAL进行文献检索，以确定比较奥氮平与其他标准止吐药进行预防或解救的随机对照试验（RCT）。主要终点是在急性、延迟和总体阶段无呕吐或无恶心的患者百分比。
在预防组中确定了10项RCT，在突破性组中确定了3项RCT。亚组分析表明，5毫克和10毫克剂量的奥氮平在总体阶段无呕吐终点方面的获益程度相似。在预防组中，奥氮平在六个终点中的五个终点上具有统计学优势，在六个终点中的四个终点上具有临床优势。在突破性组中，奥氮平在所分析的唯一终点（无呕吐）上具有统计学和临床优势。
奥氮平在CINV解救方面比其他标准止吐药更有效，将其纳入可改善预防组的控制效果。鉴于可能减少副作用，应考虑使用5毫克剂量的奥氮平。未来的RCT应进一步比较5毫克和10毫克剂量，并报告疗效和出现副作用的患者百分比。应在无皮质类固醇影响的情况下进行进一步分析。
