# Confirm low-dose olanzapine for appetite and weight in advanced cancer worldwide

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

## TL;DR

A randomised placebo-controlled trial at Tata Memorial found that 2.5 mg of olanzapine daily, a cheap antipsychotic pill already used for chemotherapy nausea, improved appetite and weight gain in patients starting chemotherapy for advanced stomach, lung and hepatopancreatobiliary cancers. A multinational confirmatory trial is needed before guidelines and labels adopt it.

## Summary

A randomised placebo-controlled trial from Tata Memorial (published in the Journal of Clinical Oncology, 2023) found that 2.5 mg olanzapine daily improved weight gain and appetite in chemotherapy-naive patients with advanced gastric, lung and hepatopancreatobiliary cancers, an area where expensive investigational agents have repeatedly failed. Olanzapine costs cents and is already used for chemotherapy-induced nausea. The proposal is a multinational confirmatory trial with weight, appetite, quality of life and survival endpoints, coupled with a guideline and label strategy so the result reaches patients.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Low-dose olanzapine increases the proportion of patients with advanced cancer gaining more than 5% body weight at 12 weeks by at least 20 absolute percentage points versus placebo, with improved appetite scores and no excess sedation.
- Rationale: The initial trial effect was large and the drug's safety at 2.5 mg is well established; cachexia has no approved effective drug in most countries, and a generic solution would be adopted immediately if confirmed.
- Proposed test: Randomised placebo-controlled trial of about 500 patients across three continents with weight gain primary endpoint, followed by ESMO and ASCO guideline submissions.
- Maturity: early-clinical
- Actor: research

## Sources

- Bottleneck evidence (No incentive to repurpose cheap drugs): Pantziarka et al., The Repurposing Drugs in Oncology (ReDO) Project (ecancer 2014): https://doi.org/10.3332/ecancer.2014.442

## Connected records

- cancers: [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- institutions: [Tata Memorial Centre](https://onco.cc/institutions/tata-memorial/)
- bottlenecks: [Cachexia, toxicity and the limits of the patient](https://onco.cc/bottlenecks/b-cachexia-supportive/), [No incentive to repurpose cheap drugs](https://onco.cc/bottlenecks/b-generic-repurposing/)
- key papers: [The Repurposing Drugs in Oncology (ReDO) Project](https://onco.cc/key-papers/paper-pantziarka-ecancermedicalscience/)
- trials: [Low-dose olanzapine for cancer anorexia (Tata Memorial)](https://onco.cc/trials/olanzapine-appetite-tmh/)

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