Anorexia is a significant element of the wasting disorder cachexia, which affects approximately one-third of people with cancer. There are currently no drugs approved for the treatment of cancer-associated cachexia, but researchers have explored potential therapeutics, including appetite-stimulating treatments, with mixed results. Recently, olanzapine (an atypical antipsychotic medication approved for several mental health conditions) has been shown to have rapid onset of effect on appetite. Study results published in the Journal of the National Comprehensive Cancer Network (JNCCN) suggest it may have a potential role in promoting appetite and weight gain in patients with cancer and cachexia.
A double-blind, placebo-controlled, randomized trial conducted at the Kasr Al-Ainy Center, Cairo University Hospitals, Egypt, investigated the potential effects of olanzapine on cancer cachexia-associated anorexia in patients with incurable cancer and no significant baseline nausea. Patients taking olanzapine had significantly reduced median scores for anorexia and nausea on the Edmonton Symptom Assessment Scale from baseline to day 8, and weight gain (a secondary endpoint) from baseline to day 29. There was no significant difference in survival between groups. Nonetheless, grade 3 or higher anemia and leukopenia were more common in the olanzapine group, and the rate of serious adverse events was also higher among these patients. The most common serious adverse event was severe anemia, and 2 patients were hospitalized for hyperglycemia. This toxicity profile differs from that in prior studies of olanzapine in clinical trials in mental health settings. In the context of the pretreated advanced cancer study population, many patients were receiving palliative therapies and pain-management strategies (eg, opioids and/or adjuvant analgesics), and many had comorbidities (eg, one-quarter had diabetes), which may have contributed to the different toxicity profile observed in this study vs studies in mental health settings.
High level
While targeted therapies may change cachexia management in the future, appetite stimulants will likely remain important, especially for patients with advanced stages of disease, where the priority is alleviating anorexia and body image distress. This study supports the potential use of olanzapine as an appetite stimulant in patients with cancer and cachexia without significant nausea, albeit at the potential cost of additional hematologic toxicity. Given the known antinausea effects of olanzapine, the study authors suggest that it may also be beneficial for patients with cancer cachexia and nausea, but further studies are needed to confirm this. Other areas for future research include investigation of the effects of olanzapine on muscle strength in patients with cancer cachexia and exploration of different doses and durations of olanzapine to strike a balance between toxicity and improvements in appetite and other cachexia-relevant outcomes.
Ground level
The results of this study showed a positive effect of a short course of olanzapine on anorexia in patients with incurable cancer and cachexia. In light of these results, oncologists should watch for the development of expert guidance on whether and how olanzapine could be included in treatment paradigms as an alternative to corticosteroids and progestins for appetite stimulation in oncology settings.