{"entity":{"id":"olanzapine-appetite-tmh","kind":"trial","name":"Low-dose olanzapine for cancer anorexia (Tata Memorial)","aka":[],"tldr":"A double-blind trial at Tata Memorial in India randomised 124 patients starting chemotherapy to 2.5 mg of olanzapine, a decades-old tablet costing a few cents a day, or placebo. Six in ten gained more than 5% of their weight against one in ten on placebo, and ASCO listed it in its 2024 cachexia guideline; it was small and single-centre.","summary":"124 patients were randomised, double-blind. The primary endpoint, weight gain over 5% at 12 weeks, was achieved by 60% of patients on olanzapine vs 9% on placebo; appetite improved (visual analogue scale) in 43% vs 13%, and quality of life and chemotherapy toxicity scores favoured olanzapine. Adverse events were minimal at this dose (no excess sedation or metabolic effects over 12 weeks). The trial led ASCO to list low-dose olanzapine as an option in its 2024 cachexia guideline update. It is small, single-centre and short, and did not measure lean mass or survival; a multi-country replication is the obvious next step. Its significance is access: olanzapine is on the WHO essential medicines list and costs a few cents a day.","status":"positive","asOf":"2026-09-08","links":[{"label":"Sandhya et al. (JCO 2023)","url":"https://doi.org/10.1200/JCO.22.01997"}],"tags":[],"related":["idea-bio2-low-dose-olanzapine-appetite","idea-reg-olanzapine-cachexia-global-confirmation","who-essential-medicines"],"cancers":["gastric","nsclc","pancreatic","hcc"],"sections":["nutrition-lifestyle","supportive-care"],"technologies":["cachexia-appetite-pharmacotherapy","antiemetic-therapy","drug-repurposing"],"targets":[],"drugs":[],"companies":[],"institutions":["tata-memorial"],"pathways":[],"terms":["cachexia","nutrition-impact-symptoms"],"trials":[],"people":["gupta-sudeep"],"bottlenecks":["b-cachexia-supportive","b-generic-repurposing","b-global-access"],"keyPapers":["paper-sandhya-j-clin-oncol"],"journals":[],"dependsOn":[],"notes":[],"phase":"3","setting":"Untreated, locally advanced or metastatic gastric, hepatopancreaticobiliary or lung cancer starting chemotherapy: olanzapine 2.5 mg daily vs placebo for 12 weeks, plus standard nutritional advice","sponsor":"Tata Memorial Centre","result":"Weight gain over 5%: 60% vs 9%; appetite improvement 43% vs 13%.","yearReported":2023,"enrolled":124,"enrolledBasis":"registry","outcomes":[{"endpoint":"Weight gain greater than 5% at 12 weeks","primary":true,"unit":"%","arms":[{"name":"Olanzapine 2.5 mg","n":63,"value":60},{"name":"Placebo","n":61,"value":9}],"p":"<0.001","source":"https://doi.org/10.1200/JCO.22.01997"}],"replication":"Not yet replicated; consistent with olanzapine's antiemetic trials and with an earlier small Indian randomised trial with megestrol."},"route":"/trials/olanzapine-appetite-tmh/","neighbours":{"idea":[{"id":"idea-bio2-low-dose-olanzapine-appetite","kind":"idea","name":"A cheap old tablet to restore appetite","route":"/ideas/idea-bio2-low-dose-olanzapine-appetite/"},{"id":"idea-reg-olanzapine-cachexia-global-confirmation","kind":"idea","name":"Confirm low-dose olanzapine for appetite and weight in advanced cancer worldwide","route":"/ideas/idea-reg-olanzapine-cachexia-global-confirmation/"}],"term":[{"id":"double-blind","kind":"term","name":"Blinding (double-blind, open-label, placebo-controlled)","route":"/terms/double-blind/"},{"id":"cachexia","kind":"term","name":"Cancer cachexia","route":"/terms/cachexia/"},{"id":"ethics-review","kind":"term","name":"Ethics review (IRB, research ethics committee)","route":"/terms/ethics-review/"},{"id":"n-of-1-trial","kind":"term","name":"N-of-1 trial","route":"/terms/n-of-1-trial/"},{"id":"nutrition-impact-symptoms","kind":"term","name":"Nutrition impact symptoms","route":"/terms/nutrition-impact-symptoms/"},{"id":"placebo","kind":"term","name":"Placebo","route":"/terms/placebo/"},{"id":"who-essential-medicines","kind":"term","name":"WHO Essential Medicines List for cancer","route":"/terms/who-essential-medicines/"}],"cancer":[{"id":"gastric","kind":"cancer","name":"Gastric & gastro-oesophageal junction cancer","route":"/cancers/gastric/"},{"id":"hcc","kind":"cancer","name":"Hepatocellular carcinoma","route":"/cancers/hcc/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"}],"section":[{"id":"nutrition-lifestyle","kind":"section","name":"Diet, Exercise & Lifestyle","route":"/fronts/nutrition-lifestyle/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"antiemetic-therapy","kind":"technology","name":"Antiemetics for chemotherapy-induced nausea and vomiting","route":"/technologies/antiemetic-therapy/"},{"id":"cachexia-appetite-pharmacotherapy","kind":"technology","name":"Cachexia pharmacotherapy: GDF-15 blockade, anamorelin, olanzapine","route":"/technologies/cachexia-appetite-pharmacotherapy/"},{"id":"drug-repurposing","kind":"technology","name":"Systematic drug repurposing","route":"/technologies/drug-repurposing/"}],"institution":[{"id":"tata-memorial","kind":"institution","name":"Tata Memorial Centre","route":"/institutions/tata-memorial/"}],"person":[{"id":"gupta-sudeep","kind":"person","name":"Sudeep Gupta","route":"/people/gupta-sudeep/"}],"bottleneck":[{"id":"b-cachexia-supportive","kind":"bottleneck","name":"Cachexia, toxicity and the limits of the patient","route":"/bottlenecks/b-cachexia-supportive/"},{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/"},{"id":"b-generic-repurposing","kind":"bottleneck","name":"No incentive to repurpose cheap drugs","route":"/bottlenecks/b-generic-repurposing/"}],"paper":[{"id":"paper-sandhya-j-clin-oncol","kind":"paper","name":"Randomized Double-Blind Placebo-Controlled Study of Olanzapine for Chemotherapy-Related Anorexia in Patients With Locally Advanced or Metastatic Gastric, Hepatopancreaticobiliary, and Lung Cancer","route":"/key-papers/paper-sandhya-j-clin-oncol/"}],"roadmap":[{"id":"chemotherapy-roadmap","kind":"roadmap","name":"Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs","route":"/roadmaps/chemotherapy-roadmap/"},{"id":"nutrition-lifestyle-roadmap","kind":"roadmap","name":"Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment","route":"/roadmaps/nutrition-lifestyle-roadmap/"},{"id":"survivorship-roadmap","kind":"roadmap","name":"Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards","route":"/roadmaps/survivorship-roadmap/"}]}}