School of Medicine Publications
Document Type
Article
Publication Date
4-26-2026
Abstract
Background: Chemotherapy-induced nausea and vomiting is common in patients who receive highly emetogenic chemotherapy (HEC). Olanzapine acts on multiple neurotransmitters and effectively reduces delayed-phase nausea.
Aim: To compare the safety and efficacy of olanzapine-based vs neurokinin-1 receptor antagonist-based antiemetic regimens in adults receiving HEC.
Methods: This review followed Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guidelines and searched various databases like PubMed, Scopus, etc., between 2020-2025. 14 studies were included in the systematic review with 11 meeting the criteria for meta-analysis. Primary outcomes were complete response (no vomiting, no rescue medication) and nausea control during acute (0-24 hours), delayed (25-120 hours), and overall (0-120 hours) phases. Data were pooled using random-effects models. Risk of bias was assessed with Cochrane risks of bias 2.0 and risk of bias in nonrandomized studies of interventions version I tools.
Results: Olanzapine-based regimens showed higher nausea control, with no-nausea rates of 89% vs 76% (P < 0.001) and 96% vs 87% (P = 0.005). Acute complete response ranged from 66% to 100%, delayed complete response from 55% to 94%, and overall complete response from 63% to 91%. The pooled complete response odds ratio was 48.68 (95% confidence interval: 8.33-284.64; P < 0.0001). Sedation occurred in 10%-53% of patients and showed dose dependence, with lower rates at 5 mg. Most studies showed low risk of bias and high methodological quality, supporting reliability of pooled estimates despite high heterogeneity (I 2 > 95%).
Conclusion: Olanzapine-based regimens are at least as effective as neurokinin-1 antagonist therapy for chemotherapy-induced nausea and vomiting in HEC, particularly for delayed nausea. Low-dose (5 mg) olanzapine provides effective, well-tolerated, oral, and cost-efficient prophylaxis, supporting its use as a first-line antiemetic.
Recommended Citation
Mv, A., Anand, N., Babu, B., Awosika, A., Udayan, U., Mendoza, J., ... & Gadad, B. S. (2026). Olanzapine-based vs neurokinin-1 receptor antagonist antiemetic regimens in highly emetogenic chemotherapy: Systematic review and meta-analysis of efficacy and safety. World Journal of Clinical Cases, 14(12), 119112. https://doi.org/10.12998/wjcc.v14.i12.119112
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
Publication Title
World Journal of Clinical Cases
DOI
10.12998/wjcc.v14.i12.119112
Academic Level
faculty
Mentor/PI Department
Medical Education
Comments
©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license. No commercial re-use.