Olanzapine Antiemetic — SCE Medical Oncology MCQ

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ModerateSupportive & Palliative OncologyOlanzapine AntiemeticSCE Medical Oncology

A 70-year-old man with advanced gastric cancer has chemotherapy-induced nausea poorly controlled by ondansetron and dexamethasone. Cisplatin-based chemotherapy is classified as highly emetogenic. What fourth anti-emetic can be added to improve control?

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Correct answer: A — Olanzapine (5 mg for 4 days from day 1 of chemotherapy)

Olanzapine (atypical antipsychotic with multi-receptor activity including 5-HT2/3, D2, H1, muscarinic) has been added to the standard 3-drug anti-emetic regimen (5-HT3 RA + NK1 RA + dexamethasone) as a fourth agent for highly emetogenic chemotherapy. The Navari et al NEJM 2016 trial showed olanzapine 10 mg significantly improved nausea control. ESMO/MASCC 2024 guidelines now recommend olanzapine 5 mg (lower dose for less sedation) as part of the 4-drug antiemetic regimen for cisplatin-based chemotherapy.

Reference: ESMO/MASCC 2024 Antiemetic Guidelines; Navari et al NEJM 2016