Olanzapine-Based Triple Regimens Versus Neurokinin-1 Receptor Antagonist-Based Triple Regimens in Preventing Chemotherapy-Induced Nausea and Vomiting Associated with Highly Emetogenic Chemotherapy: A Network Meta-Analysis

Abstract

Background: The current antiemetic prophylaxis for patients treated with highly emetogenic chemotherapy (HEC) included the olanzapine-based triplet and neurokinin-1 receptor antagonists (NK-1RAs)-based triplet. However, which one shows better antiemetic effect remained unclear.

Materials and methods: We systematically reviewed 43 trials, involving 16,609 patients with HEC, which compared the following antiemetics at therapeutic dose range for the treatment of chemotherapy-induced nausea and vomiting: olanzapine, aprepitant, casopitant, fosaprepitant, netupitant, and rolapitant. The main outcomes were the proportion of patients who achieved no nausea, complete response (CR), and drug-related adverse events. A Bayesian network meta-analysis was performed.

Results: Olanzapine-based triple regimens showed significantly better no-nausea rate in overall phase and delayed phase than aprepitant-based triplet (odds ratios 3.18, 3.00, respectively), casopitant-based triplet (3.78, 4.12, respectively), fosaprepitant-based triplet (3.08, 4.10, respectively), rolapitant-based triplet (3.45, 3.20, respectively), and conventional duplex regimens (4.66, 4.38, respectively). CRs of olanzapine-based triplet were roughly equal to different NK-1RAs-based triplet but better than the conventional duplet. Moreover, no significant drug-related adverse events were observed in olanzapine-based triple regimens when compared with NK-1RAs-based triple regimens and duplex regimens. Additionally, the costs of olanzapine-based regimens were obviously much lower than the NK-1RA-based regimens.

Conclusion: Olanzapine-based triplet stood out in terms of nausea control and drug price but represented no significant difference of CRs in comparison with NK-1RAs-based triplet. Olanzapine-based triple regimens should be an optional antiemetic choice for patients with HEC, especially those suffering from delayed phase nausea.

Implications for practice: According to the results of this study, olanzapine-based triple antiemetic regimens were superior in both overall and delayed-phase nausea control when compared with various neurokinin-1 receptor antagonists-based triple regimens in patients with highly emetogenic chemotherapy (HEC). Olanzapine-based triplet was outstanding in terms of nausea control and drug price. For cancer patients with HEC, especially those suffering from delayed-phase nausea, olanzapine-based triple regimens should be an optional antiemetic choice.

Keywords: Chemotherapy‐induced nausea and vomiting; Highly emetogenic chemotherapy; Nausea; Network meta‐analysis; Neurokinin‐1 receptor antagonists; Olanzapine.

Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

© AlphaMed Press 2018.

Figures

Figure 1.

Flow diagram of the study selection for the comparison of olanzapine‐based triple regimens and neurokinin‐1 receptor antagonists‐based regimens in patients with HEC. Abbreviations: AUC, area under the curve; CINV, chemotherapy‐induced nausea and vomiting; HEC, highly emetogenic chemotherapy; MEC, moderately emetogenic chemotherapy.

Figure 2.

Network established for multiple treatment comparisons of olanzapine‐based triple regimens and different neurokinin‐1 receptor antagonists‐based triple regimens for patients with highly emetogenic chemotherapy. Abbreviation: 5‐HT3RA, serotonin receptor antagonist.

Figure 3.

Distribution of probabilities of each chemotherapy‐induced nausea and vomiting regimen being ranked first place based on network, classified by regimens (A) and by outcomes (B). Abbreviations: 5‐HT3RA, serotonin receptor antagonist; AP, acute phase; CR, complete response; DEX, dexamethasone; DP, delayed phase; DRAE, drug‐related adverse event; OP, overall phase.