Olanzapine ondansetron dexamethasone regime versus aprepitant palonosetron dexamethasone regime for the prevention of chemotherapy-induced nausea and vomiting: rcc study

Background: At the outset of olanzapine gaining popularity as a drug for Chemotherapy induced nausea and vomiting(CINV). Study was conducted with the aim to compare to antiemetic regimes Olanzapine, Ondansetron, Dexamethasone (OOD) with Aprepitant, Palonosetron, Dexamethasone (APD) in patients receiving highly emetogenic chemotherapy. Method: A double bind randomized control study was performed to compare the two antiemetic regimes in patients receiving HEC (Cisplatin>70mg/m2 or Doxorubicin>50mg/m2 and Cyclophosphamide>500mg/m2) with complete response (CR) defined as no vomiting and no rescue (till 5 days post chemotherapy) as the primary endpoint. 270 patients initially allotted to the study of which finally 230 were available for evaluation Results: The primary endpoint of CR was 75% for overall period (92% early period and 75% delayed period) for the OOD arm whereas overall was 70% (81% early period and 70% delayed period) for the APD arm where early period is defined as first 24 hours and delayed as day 2 to day 5 .Nausea control as per MD Anderson Symptom Inventory (MDASI) based questionnaire was better in OOD (60%) vs APD (53%) arm. There was no statistically significant difference between the arms (P>0.05).hence OOD was comparable with APD for prevention of CINV Discussion: study points out an significantly cheaper yet effective option in managing CINV which is a major adverse effect of chemotherapy with repercussions in quality of life and adherence to treatment. The cost factor is of greater significance for a developing country like ours.