Introduction
The Children’s Oncology Group (COG) has endorsed guidelines on
chemotherapy-induced nausea and vomiting (CINV) in pediatric cancer
patients.[1-3] The current recommendations for the prevention of
CINV in pediatric patients receiving highly emetogenic chemotherapy
(HEC) include a three-drug CINV prophylaxis regimen consisting of an NK1
receptor antagonist, a 5-HT3 receptor antagonist, and a
corticosteroid.[1-3] A recently published randomized controlled
trial demonstrated improved CINV control with the addition of olanzapine
to this existing backbone to create a four-drug CINV prophylaxis
regimen. In this study, a higher proportion of patients who received
olanzapine as part of a four-drug regimen achieved a complete response
(no emesis or use of rescue medication) in the acute phase (78% v 59%,
p=0.001) than the control group.[4]
While evidence exists to support the addition of olanzapine to
three-drug CINV prophylaxis, there are not available data to support the
substitution of olanzapine in patients who are unable to receive a
corticosteroid. Circumstances where clinicians may want to avoid
corticosteroids as an antiemetic include patients with brain tumors and
acute myeloid leukemia.[5] The COG supportive care endorsed
guidelines on CINV management acknowledge such circumstances exist;
however, the guidelines do not provide many alternative options to
ensure appropriate prophylaxis is administered. This study aims to
describe the efficacy of olanzapine, in place of dexamethasone, in
combination with fosaprepitant and a 5HT3-antagonist on CINV prevention
in children.