From the Guidelines
The most effective treatment for chronic nausea and vomiting in an ovarian cancer patient is a multi-modal approach, starting with octreotide, as recommended by the most recent and highest quality study 1. This approach is based on the latest evidence, which suggests that octreotide should be utilized in the treatment of nausea and vomiting due to bowel obstruction caused by cancer, with a high recommendation and intermediate quality evidence 1.
Key Considerations
- Octreotide is a somatostatin analogue that can help reduce nausea and vomiting by decreasing gastrointestinal secretions and slowing gut motility.
- The use of octreotide is supported by a high recommendation and intermediate quality evidence, making it a reliable treatment option for ovarian cancer patients with chronic nausea and vomiting 1.
- In addition to octreotide, other medications such as 5-HT3 receptor antagonists (e.g., ondansetron) can be added to control nausea and vomiting when the first-line medications are unable to control the symptoms, as suggested by the latest guidelines 1.
Treatment Approach
- Start with octreotide, as recommended by the latest guidelines 1.
- Consider adding a 5-HT3 receptor antagonist, such as ondansetron, to enhance antiemetic effects.
- Ensure proper hydration, consider smaller, more frequent meals, and avoid strong odors or triggering foods to help manage symptoms.
- The specific regimen should be tailored based on the patient's disease stage, and individual response to medications, with adjustments made as needed for optimal symptom control.
Additional Options
- Metoclopramide or prochlorperazine can be used for breakthrough nausea, as they target dopaminergic pathways and can help reduce nausea and vomiting 1.
- Neurokinin-1 receptor antagonists, such as aprepitant, can be considered for persistent symptoms, as they block substance P and can help reduce nausea and vomiting.
- Olanzapine can be used for persistent symptoms, as it has antiemetic effects and can help reduce nausea and vomiting.
From the FDA Drug Label
- 1 Prevention of Chemotherapy-Induced Nausea and Vomiting Highly Emetogenic Chemotherapy In 2 randomized, double-blind, monotherapy trials, a single 24 mg oral dose of ondansetron tablets was superior to a relevant historical placebo control in the prevention of nausea and vomiting associated with highly emetogenic cancer chemotherapy, including cisplatin greater than or equal to 50 mg/m 2
The best treatment for chronic nausea and vomiting in an ovarian cancer patient is ondansetron 24 mg orally, as it has been shown to be effective in preventing nausea and vomiting associated with highly emetogenic chemotherapy, including cisplatin.
- Key points:
- A single 24 mg oral dose of ondansetron tablets was superior to a historical placebo control in preventing nausea and vomiting.
- Ondansetron was effective in patients receiving chemotherapy regimens containing cisplatin greater than or equal to 50 mg/m 2.
- The recommended dosage is 24 mg orally 2.
From the Research
Treatment Options for Chronic Nausea and Vomiting in Ovarian Cancer Patients
- The treatment of chronic nausea and vomiting in ovarian cancer patients can be challenging, but several options are available 3, 4, 5, 6, 7.
- According to a study published in 2015, dronabinol can be an effective treatment for refractory nausea and vomiting in patients with advanced cancer, including those with ovarian cancer 3.
- The MASCC antiemetics in advanced cancer updated guideline recommends the following antiemetic medications:
- First-line: metoclopramide and haloperidol
- Second-line: methotrimeprazine and olanzapine
- Third-line: tropisetron and levosulpiride 4
- A study published in 2020 found that olanzapine 5 mg combined with standard antiemetic therapy can be effective in preventing chemotherapy-induced nausea and vomiting in patients undergoing cisplatin-based chemotherapy 7.
- Another study published in 2020 discussed the management of nausea and vomiting associated with poly(ADP-ribose) polymerase inhibitor therapy for advanced ovarian cancer, highlighting the need for effective antiemetic agents and management strategies 6.
- The evaluation and treatment of nausea and vomiting in adults, including those with ovarian cancer, require a careful history and physical examination to guide the initial evaluation and narrow the differential diagnosis 5.
Antiemetic Medications
- Metoclopramide: a first-line antiemetic medication for nausea and vomiting in advanced cancer 4
- Haloperidol: a first-line antiemetic medication for nausea and vomiting in advanced cancer 4
- Olanzapine: a second-line antiemetic medication for nausea and vomiting in advanced cancer, and also effective in preventing chemotherapy-induced nausea and vomiting 4, 7
- Dronabinol: an effective treatment for refractory nausea and vomiting in patients with advanced cancer, including those with ovarian cancer 3