Olanzapine versus Aprepitant as Add on Therapies in Chemotherapy Induced Nausea and Vomiting (CINV): A Prospective Observational study

Background: Chemotherapy-induced nausea and vomiting (CINV) are frequent and debilitating side effects ofchemotherapy, greatly impacting patient quality of life. Olanzapine, an atypical antipsychotic, has emerged as apotential adjunctive therapy in the management of CINV, but its effectiveness compared with standardantiemetic regimens remains understudied.Methods: This prospective observational study had 34 female patients with breast carcinoma who receivedchemotherapy regimens containing paclitaxel, cyclophosphamide, doxorubicin, epirubicin, and 5-fluorouracil.Olanzapine was used as adjunctive antiemetic therapy. Severity of nausea and vomiting was evaluated basedboth on Visual Analog Scale (VAS) and Common Terminology Criteria for Adverse Events (CTCAE) gradingscale. This was compared to the standard antiemetic regimen, aprepitant, which comprises palonosetron anddexamethasone.Results: Most patients had a significant reduction in both early and delayed nausea and vomiting, with mostreporting only mild symptoms. The most common adverse reactions were gastrointestinal in nature, includingnausea, vomiting, diarrhea, and constipation, all of which were manageable. Hematological parameters, such ashemoglobin and platelet counts, remained within normal limits, confirming that olanzapine did not adverselyaffect blood cell counts. The efficacy of olanzapine in chemotherapy-induced nausea and vomiting wassomewhat better than that of aprepitant, especially during the delayed phase.Conclusion: Olanzapine is very effective as an adjunctive treatment for chemotherapy-induced nausea andvomiting in breast cancer patients. It is highly effective in providing control over early, as well as delayed,symptoms. Additionally, olanzapine is safe and tolerable, allowing patients to remain stable duringchemotherapy. However, more extensive randomized controlled trials are needed to confirm these findings,design optimal dosing regimens, and explore the advantage of adding olanzapine to standard treatments to makethe outcomes even better for chemotherapy patients.