{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:13:00Z","timestamp":1791825180674,"version":"4.3.4"},"reference-count":53,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,2,17]],"date-time":"2024-02-17T00:00:00Z","timestamp":1708128000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institute on Minority Health","doi-asserted-by":"publisher","award":["U54MD007605"],"award-info":[{"award-number":["U54MD007605"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacy"],"abstract":"<jats:p>Background: Cancer anorexia-cachexia syndrome (CAS) is a multifactorial condition that is highly prevalent in advanced cancer patients and associated with significant reduction in functional performance, reduction in quality of life, and increased mortality. Currently, no medications are approved for this indication. Recently, the American Society of Clinical Oncology (ASCO) released a rapid recommendation suggesting that low-dose olanzapine once daily may be used to treat cancer cachexia. Many questions still exist on how to use olanzapine for this indication in clinical practice. The objective of this review is to identify existing knowledge on the use of olanzapine for CAS. Methods: A comprehensive search was conducted to identify the primary literature that involved olanzapine for anorexia and cachexia in cancer patients between 2000 and 2023. Results: Seven articles were identified and are discussed here, including two randomized double-blinded placebo-controlled studies, one randomized comparative study, two prospective open-label studies, one retrospective chart review, and one case report. Conclusions: Low dose olanzapine (2.5\u20135 mg once daily) may be useful in the treatment of CAS for increasing appetite, reducing nausea and vomiting, and promoting weight gain. Further large-scale multi-center randomized placebo-controlled studies will be needed to investigate the impact of olanzapine on weight change in CAS patients.<\/jats:p>","DOI":"10.3390\/pharmacy12010034","type":"journal-article","created":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T11:23:57Z","timestamp":1708341837000},"page":"34","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["A Review of Olanzapine in the Treatment of Cancer Anorexia-Cachexia Syndrome"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0557-2297","authenticated-orcid":false,"given":"Ivy O.","family":"Poon","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice, Texas Southern University, Houston, TX 77004, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Ajewole","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, Texas Southern University, Houston, TX 77004, USA"},{"name":"Pharmacy Department, Houston Methodist Hospital, Houston, TX 77004, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ursula K.","family":"Braun","sequence":"additional","affiliation":[{"name":"Rehabilitation & Extended Care Line, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA"},{"name":"Section of Geriatrics & Palliative Medicine, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/S0149-2918(05)80001-3","article-title":"Prognostic Effect of Weight Loss Prior to Chemotherapy in Cancer Patients. Eastern Cooperative Oncology Group","volume":"69","author":"Dewys","year":"1980","journal-title":"Am. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Poulia, K.A., Sarantis, P., Antoniadou, D., Koustas, E., Papadimitropoulou, A., Papavassiliou, A.G., and Karamouzis, M.V. (2020). Pancreatic Cancer and Cachexia-Metabolic Mechanisms and Novel Insights. Nutrients, 12.","DOI":"10.3390\/nu12061543"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/S1470-2045(10)70218-7","article-title":"Definition and Classification of Cancer Cachexia: An International Consensus","volume":"12","author":"Fearon","year":"2011","journal-title":"Lancet Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.ijsu.2017.01.075","article-title":"Clinical Impact of Sarcopenia on Prognosis in Pancreatic Ductal Adenocarcinoma: A Retrospective Cohort Study","volume":"39","author":"Ninomiya","year":"2017","journal-title":"Int. J. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.3945\/ajcn.116.140434","article-title":"Relation between Hypermetabolism, Cachexia, and Survival in Cancer Patients: A Prospective Study in 390 Cancer Patients before Initiation of Anticancer Therapy","volume":"105","author":"Vazeille","year":"2017","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.pan.2014.11.006","article-title":"Influence of Cachexia and Sarcopenia on Survival in Pancreatic Ductal Adenocarcinoma: A Systematic Review","volume":"15","author":"Zykus","year":"2015","journal-title":"Pancreatology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1932","DOI":"10.1002\/jcsm.13321","article-title":"Physical Function Endpoints in Cancer Cachexia Clinical Trials: Systematic Review 1 of the Cachexia Endpoints Series","volume":"14","author":"McDonald","year":"2023","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"110539","DOI":"10.1016\/j.nut.2019.06.020","article-title":"Effects of Weight Loss and Sarcopenia on Response to Chemotherapy, Quality of Life, and Survival","volume":"67\u201368","author":"Ryan","year":"2019","journal-title":"Nutrition"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1016\/j.clnu.2017.06.017","article-title":"ESPEN Expert Group Recommendations for Action against Cancer-Related Malnutrition","volume":"36","author":"Arends","year":"2017","journal-title":"Clin. Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.clnu.2009.12.004","article-title":"Consensus Definition of Sarcopenia, Cachexia and Pre-Cachexia: Joint Document Elaborated by Special Interest Groups (SIG) \u201cCachexia-Anorexia in Chronic Wasting Diseases\u201d and \u201cNutrition in Geriatrics\u201d","volume":"29","author":"Muscaritoli","year":"2010","journal-title":"Clin. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: Revised European Consensus on Definition and Diagnosis","volume":"48","author":"Bahat","year":"2019","journal-title":"Age Ageing"},{"key":"ref_12","unstructured":"(2023, November 18). The Anorexia-Cachexia Syndrome: Definitions, Evaluation, and Non-Pharmacologic Management. Palliative Care Network of Wisconsin. Available online: https:\/\/www.mypcnow.org\/fast-fact\/the-anorexia-cachexia-syndrome-definitions-evaluation-and-non-pharmacologic-management\/."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"287457","DOI":"10.1155\/2012\/287457","article-title":"Leptin in Anorexia and Cachexia Syndrome","volume":"2012","author":"Engineer","year":"2012","journal-title":"Int. J. Pept."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1177\/0884533617722986","article-title":"Cancer Cachexia: Cause, Diagnosis, and Treatment","volume":"32","author":"Mattox","year":"2017","journal-title":"Nutr. Clin. Pract."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2341","DOI":"10.1007\/s00520-015-2606-z","article-title":"Validation and Real-World Assessment of the Functional Assessment of Anorexia-Cachexia Therapy (FAACT) Scale in Patients with Advanced Non-Small Cell Lung Cancer and the Cancer Anorexia-Cachexia Syndrome (CACS)","volume":"23","author":"LeBlanc","year":"2015","journal-title":"Support Care Cancer"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2438","DOI":"10.1200\/JCO.20.00611","article-title":"Management of Cancer Cachexia: ASCO Guideline","volume":"38","author":"Roeland","year":"2020","journal-title":"J. Clin. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"4178","DOI":"10.1200\/JCO.23.01280","article-title":"Cancer Cachexia: ASCO Guideline Rapid Recommendation Update","volume":"41","author":"Roeland","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Almeida, O.L.S., Ferriolli, E., Taveira, R.C.C., Rosenburg, M.G., Campanari, D.D., da Cruz Alves, N.M., Pfrimer, K., Rapatoni, L., Peria, F.M., and Lima, N.K.C. (2023). Mirtazapine versus Megestrol in the Treatment of Anorexia-Cachexia Syndrome in Patients with Advanced Cancer: A Randomized, Double-Blind, Controlled Phase II Clinical Trial. Cancers, 15.","DOI":"10.3390\/cancers15143588"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1177\/1049909109345685","article-title":"Phase II Trial of Mirtazapine for Cancer-Related Cachexia and Anorexia","volume":"27","author":"Riechelmann","year":"2010","journal-title":"Am. J. Hosp. Palliat. Care"},{"key":"ref_20","unstructured":"(2023, November 14). \u201cOlanzapine (Generic).\u201d The Brown University Psychopharmacology Update 34, no. 2 (2023): NA. Gale Academic OneFile. Available online: https:\/\/link.gale.com\/apps\/doc\/A733219735\/AONE?u=anon~890103d0&sid=googleScholar&xid=e72ad14e."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1111\/j.1365-2354.2006.00760.x","article-title":"Cancer Chemotherapy and Cachexia: Mirtazapine and Olanzapine Are 5-HT3 Antagonists with Good Antinausea Effects","volume":"16","author":"Kast","year":"2007","journal-title":"Eur. J. Cancer Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s11864-020-00804-1","article-title":"The Benefits of Olanzapine in Palliating Symptoms","volume":"22","author":"Davis","year":"2021","journal-title":"Curr. Treat. Options Oncol."},{"key":"ref_23","unstructured":"Brunton, L.L., Hilal-Dandan, R., and Knollmann, B.C. (2017). Goodman & Gilman\u2019s: The Pharmacological Basis of Therapeutics, McGraw Hill."},{"key":"ref_24","unstructured":"Lee, S., Lee, S., and Shin, J. (2013). Pharmacogenomics: An Introduction and Clinical Perspective, McGraw Hill. Chapter 6A. Pharmacogenetics of Cytochrome P450."},{"key":"ref_25","unstructured":"(2023, November 18). Home of Fast Facts and Fast Fact CME. Palliative Care Network of Wisconsin. Available online: https:\/\/www.mypcnow.org\/."},{"key":"ref_26","unstructured":"(2023, November 18). Home|ClinicalTrials.gov, Available online: https:\/\/clinicaltrials.gov\/."},{"key":"ref_27","first-page":"303","article-title":"Zotero: A Bibliographic Assistant to Researcher","volume":"2","author":"Ahmed","year":"2011","journal-title":"J. Pharmacol. Pharmacother."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.jclinepi.2021.03.001","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"134","author":"Page","year":"2021","journal-title":"J. Clin. Epidemiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1272\/manms.8.195","article-title":"Treatment of Cancer and Palliative Care (3) Treatment of Cancer-Related Anorexia with Olanzapine","volume":"8","author":"Nakamura","year":"2012","journal-title":"Nihon Ika Daigaku Igakkai Zasshi"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"20529","DOI":"10.1200\/jco.2008.26.15_suppl.20529","article-title":"Phase I Pilot Study of the Safety and Tolerability of Olanzapine (OZA) for the Treatment of Cachexia in Patients with Advanced Cancer","volume":"26","author":"Braiteh","year":"2008","journal-title":"J. Clin. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1007\/s00520-009-0739-7","article-title":"Treatment of Cancer-Related Anorexia with Olanzapine and Megestrol Acetate: A Randomized Trial","volume":"18","author":"Navari","year":"2010","journal-title":"Support Care Cancer"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2649","DOI":"10.1007\/s00520-015-2625-9","article-title":"Olanzapine for Cachexia in Patients with Advanced Cancer: An Exploratory Study of Effects on Weight and Metabolic Cytokines","volume":"23","author":"Naing","year":"2015","journal-title":"Support Care Cancer"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2617","DOI":"10.1200\/JCO.22.01997","article-title":"Randomized Double-Blind Placebo-Controlled Study of Olanzapine for Chemotherapy-Related Anorexia in Patients with Locally Advanced or Metastatic Gastric, Hepatopancreaticobiliary, and Lung Cancer","volume":"41","author":"Sandhya","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2233","DOI":"10.2147\/CMAR.S191330","article-title":"Low-Dose of Olanzapine Has Ameliorating Effects on Cancer-Related Anorexia","volume":"11","author":"Okamoto","year":"2019","journal-title":"Cancer Manag. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1001\/jamaoncol.2020.1052","article-title":"Olanzapine for the Treatment of Advanced Cancer-Related Chronic Nausea and\/or Vomiting: A Randomized Pilot Trial","volume":"6","author":"Navari","year":"2020","journal-title":"JAMA Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"600","DOI":"10.21037\/apm-22-1167","article-title":"Benefits and Risks of Off-Label Olanzapine Use for Symptom Management in Cancer Patients\u2014A Case Report","volume":"12","author":"Dev","year":"2023","journal-title":"Ann. Palliat. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"B82","DOI":"10.1158\/1535-7163.TARG-13-B82","article-title":"Abstract B82: Olanzapine for Cachexia in Patients with Advanced Cancer","volume":"12","author":"Abdelrahim","year":"2013","journal-title":"Mol. Cancer Ther."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"S1540","DOI":"10.1016\/j.annonc.2022.10.302","article-title":"275MO Phase III Double Blind Placebo-Controlled Study of Olanzapine for Chemotherapy Related Anorexia in Patients with Advanced Gastric, Hepatopancreaticobiliary and Lung Cancer","volume":"33","author":"Singuluri","year":"2022","journal-title":"Ann. Oncol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1634","DOI":"10.1002\/1097-0142(20001001)89:7<1634::AID-CNCR29>3.0.CO;2-V","article-title":"Assessing Symptom Distress in Cancer Patients: The M.D. Anderson Symptom Inventory","volume":"89","author":"Cleeland","year":"2000","journal-title":"Cancer"},{"key":"ref_40","first-page":"2052","article-title":"By the 2023 American Geriatrics Society Beers Criteria\u00ae Update Expert Panel. American Geriatrics Society 2023 Updated AGS Beers Criteria\u00ae for Potentially Inappropriate Medication Use in Older Adults","volume":"71","author":"Samuel","year":"2023","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1111\/j.1600-0447.2004.00451.x","article-title":"Olanzapine vs. Other Antipsychotics in Actual out-Patient Settings: Six Months Tolerability Results from the European Schizophrenia Out-Patient Health Outcomes Study","volume":"111","author":"Lambert","year":"2005","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1097\/JCP.0000000000000694","article-title":"Recurrent Hyperammonemia Associated with Olanzapine","volume":"37","author":"Wu","year":"2017","journal-title":"J. Clin. Psychopharmacol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.annemergmed.2018.04.027","article-title":"Intramuscular Midazolam, Olanzapine, Ziprasidone, or Haloperidol for Treating Acute Agitation in the Emergency Department","volume":"72","author":"Klein","year":"2018","journal-title":"Ann. Emerg. Med."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Caldiroli, A., Capuzzi, E., Tagliabue, I., Capellazzi, M., Marcatili, M., Mucci, F., Colmegna, F., Clerici, M., Buoli, M., and Dakanalis, A. (2021). Augmentative Pharmacological Strategies in Treatment-Resistant Major Depression: A Comprehensive Review. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms222313070"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"911","DOI":"10.2165\/00023210-200721110-00004","article-title":"Adverse Effects of Atypical Antipsychotics: Differential Risk and Clinical Implications","volume":"21","author":"Haddad","year":"2007","journal-title":"CNS Drugs"},{"key":"ref_46","unstructured":"(2023, November 14). Drugs|AccessPharmacy|McGraw Hill Medical. Available online: https:\/\/accesspharmacy-mhmedical-com.tsu.idm.oclc.org\/drugs.aspx?gbosID=426822#monoNumber=426822&sectionID=243262078&tab=tab0."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"223","DOI":"10.4103\/2231-4040.90877","article-title":"Fast Disintegrating Tablets: Opportunity in Drug Delivery System","volume":"2","author":"Parkash","year":"2011","journal-title":"J. Adv. Pharm. Technol. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e1167","DOI":"10.1002\/cnr2.1167","article-title":"Efficacy of Olanzapine for Quality of Life Improvement among Patients with Malignant Tumor: A Systematic Review","volume":"2","author":"Ji","year":"2019","journal-title":"Cancer Rep."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1007\/s00520-021-06606-x","article-title":"Olanzapine 5 Mg vs. 10 Mg for the Prophylaxis of Chemotherapy-Induced Nausea and Vomiting: A Network Meta-Analysis","volume":"30","author":"Chow","year":"2022","journal-title":"Support Care Cancer"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/S1470-2045(19)30678-3","article-title":"Olanzapine 5 Mg plus Standard Antiemetic Therapy for the Prevention of Chemotherapy-Induced Nausea and Vomiting (J-FORCE): A Multicentre, Randomised, Double-Blind, Placebo-Controlled, Phase 3 Trial","volume":"21","author":"Hashimoto","year":"2020","journal-title":"Lancet Oncol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1176\/appi.ajp.161.3.414","article-title":"Lower Risk for Tardive Dyskinesia Associated with Second-Generation Antipsychotics: A Systematic Review of 1-Year Studies","volume":"161","author":"Correll","year":"2004","journal-title":"Am. J. Psychiatry"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/S0920-9964(97)00036-4","article-title":"The Acute and Long-Term Effect of Olanzapine Compared with Placebo and Haloperidol on Serum Prolactin Concentrations","volume":"26","author":"Crawford","year":"1997","journal-title":"Schizophr. Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1097\/JCP.0000000000001083","article-title":"Mortality Risk of Atypical Antipsychotics for Behavioral and Psychological Symptoms of Dementia: A Meta-Analysis, Meta-Regression, and Trial Sequential Analysis of Randomized Controlled Trials","volume":"39","author":"Yeh","year":"2019","journal-title":"J. Clin. Psychopharmacol."}],"container-title":["Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2226-4787\/12\/1\/34\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:01:16Z","timestamp":1760104876000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2226-4787\/12\/1\/34"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,17]]},"references-count":53,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["pharmacy12010034"],"URL":"https:\/\/doi.org\/10.3390\/pharmacy12010034","relation":{},"ISSN":["2226-4787"],"issn-type":[{"value":"2226-4787","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,17]]}}}