Olanzapine With or Without Fosaprepitant Dimeglumine in Preventing Chemotherapy Induced Nausea and Vomiting in Cancer Patients Receiving Highly Emetogenic Chemotherapy



Status:Recruiting
Healthy:No
Age Range:18 - Any
Updated:3/7/2019
Start Date:October 15, 2018
End Date:March 2020
Contact:Rudolph Navari, MD, PhD, FACP
Email:rnavari@uabmc.edu
Phone:205-975-2833

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Olanzapine With or Without Fosaprepitant for the Prevention of Chemotherapy Induced Nausea and Vomiting (CINV)in Patients Receiving Highly Emetogenic Chemotherapy (HEC): A Phase III Randomized, Double Blind, Placebo-Controlled Trial

This randomized phase III trial studies how well olanzapine with or without fosaprepitant
work in preventing chemotherapy induced nausea and vomiting in cancer patients receiving
chemotherapy that causes vomiting. Olanzapine and fosaprepitant dimeglumine may help control
nausea and vomiting in patients during chemotherapy. Olanzapine is usually given in
combination with other drugs, including fosaprepitant dimeglumine. It is not yet known if
olanzapine when given with other drugs, is still effective without using fosaprepitant
dimeglumine for controlling nausea and vomiting.

PRIMARY OBJECTIVES:

I. To compare between the two study arms the proportion of patients with no nausea for the
overall (0-120 hours post-chemotherapy), acute (0-24 hours post-chemotherapy), and delayed
periods (24-120 hours post-chemotherapy) for patients receiving highly emetogenic
chemotherapy (HEC).

SECONDARY OBJECTIVES:

I. To compare between the two study arms the complete response (CR) rates (no emetic episodes
and no use of rescue medication) in the acute, delayed, and overall periods.

II. To compare between the two study arms, the incidences of potential toxicities that have
been ascribed to olanzapine.

III. To perform an economic evaluation of olanzapine and fosaprepitant dimeglumine
(fosaprepitant) versus (vs.) olanzapine in patients receiving HEC (noting that all patients
will also receive dexamethasone and a 5HT3 receptor antagonist).

IV. To explore the efficacy of olanzapine in chemotherapy cycles two to four, for patients
who elect to continue on the same antiemetic regimen received in cycle one, in chemotherapy
cycles two to four (continuation phase), by documenting nausea and complete response.

V. To explore the safety of olanzapine in chemotherapy cycles two to four, for patients who
elect to continue on the same antiemetic regimen received in cycle one, in chemotherapy
cycles two to four (continuation phase), by recording any adverse events or drug related
toxicities.

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM I: Patients receive palonosetron hydrochloride intravenously (IV) over 30 seconds or
ondansetron hydrochloride IV over 2-5 minutes or orally (PO) on day 1, dexamethasone PO on
days 1-4, fosaprepitant dimeglumine IV over 20-30 minutes on day 1, and olanzapine PO on days
1-4. Treatment may repeat every 4 days for up to 3 courses in the absence of disease
progression or unacceptable toxicity.

ARM II: Patients receive palonosetron hydrochloride IV over 30 seconds or ondansetron
hydrochloride IV over 2-5 minutes or PO on day 1, dexamethasone PO on days 1-4, placebo IV
over 20-30 minutes on day 1, and olanzapine PO on days 1-4. Treatment (with no placebo) may
repeat every 4 days for up to 3 courses in the absence of disease progression or unacceptable
toxicity.

After completion of study, patients are followed up periodically.

Inclusion Criteria:

- Diagnosis of malignant disease of any stage; (stage I through stage IV)

- No prior history of chemotherapy for any malignancy

- Scheduled to receive HEC (highly emetogenic chemotherapy) (either cisplatin-containing
regimen or doxorubicin and cyclophosphamide [AC]); cisplatin, given on a single day,
at a dose of >= 70 mg/m^2, with or without other chemotherapy agent(s) OR doxorubicin
(60 mg/m^2) plus cyclophosphamide (600 mg/m^2)

- No nausea or vomiting =< 24 hours prior to registration

- Negative pregnancy test (serum or urine) done =< 7 days prior to registration, for
women of childbearing potential only

* A female of childbearing potential is a sexually mature female who: 1) has not
undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally
postmenopausal for at least 12 consecutive months (i.e., has had menses at any time in
the preceding 12 consecutive months)

- No known diagnosis of dementia; patients with stable treated brain metastases are
eligible to participate

- No known history of central nervous system (CNS) disease (e.g. seizure disorder)

- No treatment with another antipsychotic agent such as risperidone, quetiapine,
clozapine, phenothiazine or butyrophenone =< 30 days prior to registration

- No chronic phenothiazine administration as an antipsychotic agent (patients may
receive prochlorperazine and other phenothiazines as rescue anti-emetic therapy)

- No use of amifostine within 7 days prior to registration

- No radiotherapy within 7 days prior to registration or planned for one week after the
current dose of chemotherapy

- No use of quinolone antibiotic therapy within 7 days prior to registration

- No chronic alcoholism (as determined by the investigator)

- No known hypersensitivity to olanzapine

- No known cardiac arrhythmia, uncontrolled congestive heart failure or acute myocardial
infarction within the previous six months

- No history of uncontrolled diabetes mellitus, i.e., no diabetic ketoacidosis; within 6
months prior to registration; patients are eligible if they have controlled diabetes
on diet, oral agents, and/or insulin

- Eastern Cooperative Oncology Group (ECOG) performance status 0, 1 or 2

- Patients must be able to read and comprehend English

- Serum creatinine =< 2.0 mg/dL =< 120 days prior to registration

- Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) =< 3 x upper limit
of normal (ULN) =< 120 days prior to registration
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777 Bannock St
Denver, Colorado 80204
(303) 436-6000
Principal Investigator: Keren Sturtz
Phone: 303-777-2663
Denver Health Medical Center Denver Health is a comprehensive, integrated organization providing level one care...
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1721 East 19th Ave., Suite #200 & #300
Denver, Colorado 80218
720-754-4800
Principal Investigator: Keren Sturtz
Phone: 303-777-2663
Colorado Blood Cancer Institute When patients come to the Colorado Blood Cancer Institute, the entire...
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Denver, Colorado 80218
Principal Investigator: Keren Sturtz
Phone: 303-777-2663
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Denver, Colorado 80218
Principal Investigator: Keren Sturtz
Phone: 303-777-2663
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Denver, Colorado 80220
Principal Investigator: Keren Sturtz
Phone: 303-777-2663
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4567 E 9th Ave
Denver, Colorado 80220
(303) 320-2121
Principal Investigator: Keren Sturtz
Phone: 303-777-2663
Rose Medical Center Well known as a Denver institution and a 9th Avenue landmark for...
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Des Moines, Iowa 50309
Principal Investigator: Robert J. Behrens
Phone: 515-282-2921
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Des Moines, Iowa 50314
Principal Investigator: Robert J. Behrens
Phone: 515-282-2200
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