Antiemetic prophylaxis with temozolomide: an audit from a tertiary care center.

BACKGROUND

In our previous experience, a significant proportion of patients who received 5-HT antagonist monotherapy with adjuvant temozolomide (150-200 mg/m) had chemotherapy-induced nausea and vomiting (CINV). This is an audit comparing the multiple antiemetic therapies in the prevention of temozolomide-associated CINV.

METHODS

This was a retrospective audit. Adult glioma patients treated with temozolomide at a dose of 150-200 mg/m between October 2017 and June 2018 were selected for this analysis. Three antiemetic prophylaxis were used in this time period: ondansetron (October 2017 to November 2017), ondansetron + domperidone (December 2017 to February 2018), and ondansetron + olanzapine (March 2018 to June 2018). The rates of nausea and vomiting were compared among the 3 cohorts using the chi-squared test with Bonferroni correction. A value of less than .016 was considered significant.

RESULTS

A total of 360 patients were selected for this analysis. There were 91 patients in the ondansetron prophylaxis group (25.3%), 113 (31.4%) in the ondansetron plus domperidone group, and 156 (43.3%) in the ondansetron plus olanzapine group. The overall incidence of nausea and vomiting was 25.0% ( = 90) and 7.2% ( = 26). Overall the rates of nausea ( = .052) and vomiting ( = .481) were similar in all 3 cohorts. However, the rates of grade 2 and above nausea ( = .012) and vomiting ( = .015) were significantly lower in the olanzapine group.

CONCLUSION

The combination of ondansetron with olanzapine leads to a statistically significant decrease in the rate of moderate-to-severe emesis and nausea and needs to be explored in a prospective study.