Bosnjak Snezana M, Dimitrijevic Jelena, Djordjevic Fedja
Department for Supportive Oncology, Institute for Oncology and Radiology of Serbia, Pasterova 14 Street, Belgrade, Serbia.
Curr Opin Support Palliat Care. 2016 Jun;10(2):180-8. doi: 10.1097/SPC.0000000000000206.
The purpose of review is to critically present the evidence supporting the use of olanzapine, an atypical antipsychotic, as an antiemetic for cancer and chemotherapy-induced nausea and vomiting (CINV).
Two phase III clinical studies demonstrated superior efficacy of olanzapine in comparison with the neurokinin-1 receptor antagonists (NK1RA) for substance P (aprepitant, fosaprepitant) in the prevention of nausea after highly emetogenic chemotherapy. Olanzapine is inexpensive and the replacement of NK1RA with olanzapine can reduce the costs of the prevention of CINV. The addition of olanzapine to aprepitant-containing combination regimens for the prevention of CINV was also investigated, and has the potential to further improve the prevention of CINV after highly emetogenic chemotherapy or moderately emetogenic chemotherapy, without substantial increase in costs. In the treatment of uncontrolled ('breakthrough') CINV, olanzapine was more effective than metoclopramide. Existing clinical data also support the use of olanzapine to relieve a cluster of gastrointestinal symptoms in patients with advanced cancer (chronic nausea, vomiting, and anorexia). When used in cancer patients, olanzapine is well tolerated, with sedation being the major dose-limiting side effect.
Existing data from clinical trials justify further research of the role of olanzapine in the prevention of CINV. Olanzapine may be used instead of or in addition to NK1RA in the preventive antiemetic regimens. Olanzapine-containing preventive regimens may provide better nausea control after chemotherapy. When used instead of NK1RA it may also provide substantial reduction in costs of CINV prevention. In patients with advanced cancer, olanzapine was effective against a cluster of gastrointestinal symptoms (nausea, vomiting, and anorexia). The use of olanzapine as an antiemetic for CINV, or to relieve nausea, vomiting, and anorexia in palliative care is currently off-label.
本综述旨在批判性地呈现支持使用非典型抗精神病药物奥氮平作为治疗癌症及化疗引起的恶心和呕吐（CINV）的止吐药的证据。
两项III期临床研究表明，与神经激肽-1受体拮抗剂（NK1RA）（用于P物质的阿瑞匹坦、福沙匹坦）相比，奥氮平在预防高致吐性化疗后恶心方面疗效更优。奥氮平价格低廉，用奥氮平替代NK1RA可降低CINV的预防成本。还研究了在含阿瑞匹坦的联合方案中添加奥氮平预防CINV，这有可能在不显著增加成本的情况下，进一步改善高致吐性化疗或中度致吐性化疗后CINV的预防效果。在治疗难治性（“突破性”）CINV方面，奥氮平比甲氧氯普胺更有效。现有临床数据也支持使用奥氮平缓解晚期癌症患者的一系列胃肠道症状（慢性恶心、呕吐和厌食）。奥氮平用于癌症患者时耐受性良好，镇静是主要的剂量限制性副作用。
临床试验的现有数据证明有必要进一步研究奥氮平在预防CINV中的作用。在预防性止吐方案中，奥氮平可替代NK-1RA或与之联用。含奥氮平的预防方案可能在化疗后更好地控制恶心。当替代NK1RA使用时，它还可能大幅降低CINV的预防成本。在晚期癌症患者中，奥氮平对一系列胃肠道症状（恶心、呕吐和厌食）有效。目前，将奥氮平用作CINV的止吐药或缓解姑息治疗中的恶心、呕吐和厌食属于超说明书用药。
