Olanzapine effective for chemotherapy-related anorexia among patients with certain cancers
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Key takeaways:
- A greater proportion of patients assigned olanzapine experienced weight gain compared with the placebo group (60% vs. 9%).
- More patients assigned olanzapine experienced improvements in appetite (43% vs. 13%).
Low-dose olanzapine significantly improved appetite and weight gain among patients with newly diagnosed cancer undergoing chemotherapy, according to study results published in Journal of Clinical Oncology.
The antipsychotic agent also appeared well-tolerated and inexpensive, researchers noted.
Rationale and methodology
Anorexia is a common problem among patients with cancer, particularly those with upper gastrointestinal and lung cancers, and may be worsened with chemotherapy, according to Prasanth Ganesan, MD, DM, researcher in the department of medical oncology at Jawaharlal Institute of Postgraduate Medical Education and Research in Dhanvantari Nagar, Puducherry, India.
“There are no good agents that can stimulate appetite at present,” Ganesan told Healio. “Steroids can be used but have several side effects. Similarly, progestins have been found to stimulate appetite but are expensive and have significant toxicities. A few studies have shown olanzapine can be used for appetite stimulation, including in patients with advanced cancer, as well as those with anorexia nervosa. Hence, we wanted to look at its effect in patients receiving chemotherapy for newly diagnosed cancer.”
Ganesan and colleagues sought to determine whether olanzapine could stimulate appetite and improve weight gain among 124 patients (median age, 55 years) with untreated, locally advanced or metastatic gastric (55%), lung (35%) or hepatopancreaticobiliary (10%) cancers undergoing chemotherapy.
The final analysis included 112 patients randomly assigned to either once-daily olanzapine dosed at 2.5 mg for 12 weeks (n = 58) or placebo (n = 54). Both groups also received standard nutritional assessment and dietary advice.
The proportion of patients with more than 5% weight gain and improvement in appetite served as primary outcomes. Secondary endpoints included change in nutritional status, quality of life and chemotherapy toxicity.
Findings
Results showed a larger proportion of patients in the olanzapine vs. placebo group experienced more than 5% weight gain (60% vs. 9%; P .001) and improvement in appetite by visual analog scale (43% vs. 13%; P .001) and by Functional Assessment of Chronic Illness Therapy System of Quality-of-Life Questionnaires Anorexia Cachexia Subscale (22% vs. 4%; P = .004).
In addition, patients assigned olanzapine experienced better quality of life and nutritional status and less chemotoxicity.
Implications
The findings indicate that olanzapine can be started for appetite stimulation among patients with newly diagnosed cancer who are at high risk for anorexia and are starting chemotherapy, Ganesan told Healio.
“Olanzapine is a safe and inexpensive option for patients. In the context of the cost of the drug in India, 3 months of olanzapine is about $3 in U.S. currency,” he said. “Though olanzapine improved appetite, there were many patients who continued to have anorexia despite this intervention. Further studies should continue to look for other agents that can help these patients. We also need to identify the effects of olanzapine when continued beyond 3 months.”
For more information:
Prasanth Ganesan, MD, DM, can be reached at prasanth.g@jipmer.ac.in.
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