{"entity":{"id":"idea-reg-olanzapine-cachexia-global-confirmation","kind":"idea","name":"Confirm low-dose olanzapine for appetite and weight in advanced cancer worldwide","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (No incentive to repurpose cheap drugs): Pantziarka et al., The Repurposing Drugs in Oncology (ReDO) Project (ecancer 2014)","url":"https://doi.org/10.3332/ecancer.2014.442"}],"tags":[],"related":[],"cancers":["gastric","nsclc","pancreatic"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":["tata-memorial"],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-generic-repurposing","b-cachexia-supportive"],"keyPapers":["paper-pantziarka-ecancermedicalscience"],"journals":[],"dependsOn":[],"notes":[],"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.","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","cost":"medium","horizonYears":3},"route":"/ideas/idea-reg-olanzapine-cachexia-global-confirmation/","neighbours":{"cancer":[{"id":"gastric","kind":"cancer","name":"Gastric & gastro-oesophageal junction cancer","route":"/cancers/gastric/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"}],"institution":[{"id":"tata-memorial","kind":"institution","name":"Tata Memorial Centre","route":"/institutions/tata-memorial/"}],"bottleneck":[{"id":"b-cachexia-supportive","kind":"bottleneck","name":"Cachexia, toxicity and the limits of the patient","route":"/bottlenecks/b-cachexia-supportive/"},{"id":"b-generic-repurposing","kind":"bottleneck","name":"No incentive to repurpose cheap drugs","route":"/bottlenecks/b-generic-repurposing/"}],"paper":[{"id":"paper-pantziarka-ecancermedicalscience","kind":"paper","name":"The Repurposing Drugs in Oncology (ReDO) Project","route":"/key-papers/paper-pantziarka-ecancermedicalscience/"}],"trial":[{"id":"olanzapine-appetite-tmh","kind":"trial","name":"Low-dose olanzapine for cancer anorexia (Tata Memorial)","route":"/trials/olanzapine-appetite-tmh/"}]}}