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ASCO 2026 | Dexamethasone-free CINV prophylaxis with olanzapine in pediatric patients

Venkatraman Radhakrishnan, MD, Cancer Institute (WIA), Chennai, India, presents findings from a Phase III non-inferiority trial (CTRI/2022/08/045009) of a dexamethasone-free olanzapine-based regimen versus standard dexamethasone-based prophylaxis for chemotherapy-induced nausea and vomiting (CINV) in children and adolescents receiving highly emetogenic chemotherapy. Non-inferiority was not demonstrated for the primary endpoint; however, complete response rates were broadly comparable across acute and delayed periods, supporting olanzapine as a viable steroid-sparing alternative in this population. This interview took place during the 2026 American Society of Clinical Oncology (ASCO) Meeting in Chicago, IL.

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Transcript

I’m the principal investigator for the CIVIC-POD trial, which is chemotherapy-induced vomiting in children, prophylaxis-omitting dexamethasone. This trial was presented at ASCO today. The basic hypothesis was that steroids are extensively used for treating or preventing vomiting in children, but we know that it’s associated with long-term toxicities. And with the advent of newer antiemetics, nobody really knows whether steroids are needed or not...

I’m the principal investigator for the CIVIC-POD trial, which is chemotherapy-induced vomiting in children, prophylaxis-omitting dexamethasone. This trial was presented at ASCO today. The basic hypothesis was that steroids are extensively used for treating or preventing vomiting in children, but we know that it’s associated with long-term toxicities. And with the advent of newer antiemetics, nobody really knows whether steroids are needed or not. And olanzapine is a drug which has been repurposed for vomiting in adults. There is data in children, but it’s limited. So we wanted to see if steroids can be replaced with olanzapine. Olanzapine compared to steroids doesn’t have that much of long-term side effects. You know, you don’t get the metabolic, the growth, the infection, and all those side effects. So in this trial, we divided a randomized patient, one is to one. One group got dex as part of the antiemetics. The other group got olanzapine or olanz as part of the antiemetics. And we showed that olanzapine was as efficacious as the DEX group in preventing nausea and vomiting in children. And it was safe to use as well. So this is the first study in children which has shown that we don’t need steroids to prevent chemotherapy-induced nausea and vomiting. And so this is a practice-changing and guideline-changing study.

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