# A cheap old tablet to restore appetite

Source: https://onco.cc/ideas/idea-bio2-low-dose-olanzapine-appetite/  
OnCo record `idea-bio2-low-dose-olanzapine-appetite` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A low dose of an old, inexpensive tablet improved appetite and weight in a randomised trial of people with advanced cancer. It could be used almost everywhere tomorrow.

## Summary

Low-dose olanzapine, at 2.5 mg daily, improved appetite, weight gain and quality of life versus placebo in a randomised trial in patients with advanced gastrointestinal and lung cancer receiving chemotherapy, conducted at Tata Memorial. The drug is generic, oral, off-patent and already used for chemotherapy-induced nausea, so implementation requires guideline change rather than development.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Low-dose olanzapine as standard supportive care for cancer-related anorexia improves weight, appetite and chemotherapy completion rates in routine practice, replicating the trial result at population scale.
- Rationale: The mechanism, appetite stimulation with a favourable metabolic profile at low dose, is well established in psychiatry, and the drug already appears in antiemetic guidelines so safety monitoring is familiar. Cost is negligible in almost every health system.
- Proposed test: Run a pragmatic multi-country replication trial, particularly in low- and middle-income settings, with appetite, weight, quality of life and metabolic adverse events as endpoints; then guideline adoption.
- Maturity: early-clinical
- Actor: clinic

## Sources

- Bottleneck evidence (Cachexia, toxicity and the limits of the patient): Fearon et al., Definition and classification of cancer cachexia (Lancet Oncology 2011): https://doi.org/10.1016/S1470-2045(10)70218-7

## Connected records

- collections: [ESMO Clinical Practice Guidelines & MCBS](https://onco.cc/collections/esmo-guidelines/), [NCCN Guidelines](https://onco.cc/collections/nccn/)
- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/)
- institutions: [Tata Memorial Centre](https://onco.cc/institutions/tata-memorial/)
- people: [Sudeep Gupta](https://onco.cc/people/gupta-sudeep/)
- bottlenecks: [Cachexia, toxicity and the limits of the patient](https://onco.cc/bottlenecks/b-cachexia-supportive/), [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [No incentive to repurpose cheap drugs](https://onco.cc/bottlenecks/b-generic-repurposing/)
- key papers: [Definition and classification of cancer cachexia: an international consensus](https://onco.cc/key-papers/paper-fearon-lancet-oncol/)
- technologies: [Cachexia pharmacotherapy: GDF-15 blockade, anamorelin, olanzapine](https://onco.cc/technologies/cachexia-appetite-pharmacotherapy/)
- trials: [Low-dose olanzapine for cancer anorexia (Tata Memorial)](https://onco.cc/trials/olanzapine-appetite-tmh/)

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