Efficacy of olanzapine combined with the standard triplet antiemetic therapy for cisplatin-based chemotherapy: A sub-analysis of a randomized, double-blind, placebo-controlled trial (J-FORCE).

Authors

null

Yukiyoshi Fujita

Division of Pharmacy, Gunma Prefectural Cancer Center, Gunma, Japan

Yukiyoshi Fujita , Masakazu Abe , Takuhiro Yamaguchi , Hiroki Ueda , Koichi Kitagawa , Jun Okamura , Katsuya Hirano , Yukio Sakata , Hirotoshi Iihara , Yasuhiro Shimada , Takeshi Aoyama , Kazuhiko Shibata , Kensuke Hori , Haruko Daga , Toshiaki Nakayama , Yasuhiko Sakata , Sadamoto Zenda , Hironobu Hashimoto

Organizations

Division of Pharmacy, Gunma Prefectural Cancer Center, Gunma, Japan, Department of Gynecologic Oncology, Shizuoka Cancer Center, Shizuoka, Japan, Division of Biostatistics, Tohoku University Graduate School of Medicine, Miyagi, Japan, Department of Medical Oncology, Wakayama Medical University Hospital, Wakayama, Japan, Division of Oncology, Kobe Minimally invasive Cancer Center, Kobe, Japan, Department of Otorhinolaryngology and Head and Neck Surgery, Seirei Hamamatsu General Hospital, Shizuoka, Japan, Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan, Department of Pharmacy, Hakodate Municipal Hospital, Hokkaido, Japan, Department of Pharmacy, Gifu University Hospital, Gifu, Japan, Clinical Oncology Division, Kochi Health Sciences Center, Kochi, Japan, Department of Pharmacy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan, Department of Medical Oncology, Kouseiren Takaoka Hospital, Toyama, Japan, Department of Obstetrics and Gynecology, Kansai Rosai Hospital, Hyogo, Japan, Department of Medical Oncology, Osaka City General Hospital, Osaka, Japan, Division of Pharmacy, Saitama Cancer Center, Saitama, Japan, Department of Pharmacy, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan, Japan Supportive, Palliative and Psychosocial Oncology Group, Tokyo, Japan, Department of Pharmacy, National Cancer Center Hospital, Tokyo, Japan

Research Funding

Other
Japan Agency for Medical Research and Development

Background: In a randomized, double-blind, placebo-controlled trial (J-FORCE), we previously reported the efficacy of olanzapine (OLZ) 5 mg plus triplet antiemetic therapy for cisplatin (CDDP)-based chemotherapy-induced nausea and vomiting (CINV) in the delayed phase (24–120 h after CDDP treatment). Here, we report the results of a pre-planned subgroup analysis of this trial (in which risk factors were used as the allocation factors). This analysis was designed to determine which patients benefit more from OLZ. Methods: Subgroup analysis was performed on complete response (CR: no emesis and no rescue medication) in the acute (within 24 h of CDDP treatment) and delayed phase and time to treatment failure (TTF: time from CDDP treatment to the first vomiting or use of rescue medication). Data from 705 patients in the efficacy analysis population (354 in the OLZ group and 351 in the placebo (PLA) group) were analyzed by sex (male/female), age (≥55 years/ < 55 years), and CDDP dose (≥70 mg/m2/ < 70 mg/m2). For CR, we calculated point estimates of differences between groups and 95% confidence intervals and performed a Mantel-Haenszel test. We used the Kaplan-Meier method for the analysis of TTF, and comparisons between groups were made using a log-rank test. Results: Delayed CR (OLZ versus PLA) and risk difference (RD) of delayed CR following OLZ treatment were significantly greater than following PLA in the following subgroups: male (83.1% versus 70.5%, RD 12.6%, p = 0.001), female (70.9% versus 56.4%, RD 14.5%, p = 0.021), age ≥55 years (78.7% versus 67.6%, RD 11.1%, p = 0.003), age < 55 years (81.0% versus 57.4%, RD 23.6%, p = 0.005), and CDDP ≥70 mg/m2 (78.8% versus 65.3%, RD 13.5%, p < 0.001). TTF of all subgroups (male/female, ≥55 years/ < 55 years, and ≥70 mg/m2/ < 70 mg/m2) was significantly longer in the OLZ group than in the PLA group (HR 0.493, p < 0.001; HR 0.612, p = 0.022; HR 0.586, p < 0.001; HR 0.401, p = 0.005; HR 0.546, p < 0.001; HR 0.543, p = 0.031, respectively). Conclusions: Our results suggest a benefit of OLZ 5 mg plus triplet therapy regardless of risk factors for CDDP-based CINV. Clinical trial information: UMIN000024676.

Olanzapine (n = 355)Placebo (n = 351)Difference95% CIp value
SexMale (n = 471)197 (83.1%)165 (70.5%)12.6%5.0–20.60.001
Female (n = 234)83 (70.9%)66 (56.4%)14.5%2.2–26.30.021
Difference12.2%14.1%p value: 0.793
Age≥55 yrs. (n = 581)229 (78.7%)196 (67.6%)11.1%3.9–18.20.003
< 55 yrs. (n = 124)51 (81.0%)35 (57.4%)23.6%7.3–38.30.005
Difference-2.3%10.2%p value: 0.158
CDDP dose<70 mg/m2 (n = 179)72 (80.0%)60 (67.4%)12.6%-0.3–25.00.0564
≥70 mg/m2 (n = 526)208 (78.8%)171 (65.3%)13.5%5.9–21.0< 0.001
Difference1.2%2.1%p value: 0.902

Disclaimer

This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org

Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Symptoms and Survivorship

Track

Symptom Science and Palliative Care

Sub Track

Palliative Care and Symptom Management

Clinical Trial Registration Number

UMIN000024676

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr 12098)

DOI

10.1200/JCO.2021.39.15_suppl.12098

Abstract #

12098

Poster Bd #

Online Only

Abstract Disclosures