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.