番茄社区

A "simple, inexpensive, well-tolerated intervention" is practically music to a cancer specialist's ears when it comes to managing chemotherapy side effects. Clinicians in India sang the praises of a commonly used low-dose, daily antipsychotic to boost appetite and weight gain in patients with newly diagnosed, advanced cancer receiving chemotherapy.

"Short-duration (1-4 days) olanzapine (doses of 5 or 10 mg per day) has become popular in oncology as a safe, effective, and inexpensive antiemetic," stated Prasanth Ganesan, MD, DM, of Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) in Puducherry, India, and colleagues, referring to a .

"However, appetite stimulation requires a more extended usage of olanzapine, which has also been deemed safe on the basis of long-term data from trials in psychiatry" -- specifically a of olanzapine versus haloperidol and a of olanzapine versus placebo, both in psychosis, the team wrote in the .

Ganesan and co-authors enrolled adults in a double-blinded, placebo-controlled trial who had different untreated, locally advanced cancers, including lung, gastric, and hepatopancreaticobiliary. A little over a third of the study population had metastatic lung cancer.

All 124 patients received olanzapine at 2.5 mg once a day for 12 weeks or placebo along with chemotherapy (a third received capecitabine and oxaliplatin). While an "individualized diet sheet was prepared and provided to all patients, emphasizing the importance of a high-calorie, high-protein, nutrient-dense healthy diet," the authors noted that "most patients hailed from poor economic conditions," so "the diet sheet stressed home-based foods, and no nutritional supplements were advised or provided."

Co-author Nirmala Devi Sreenivasan, MSc, also of JIPMER, provided dietary counseling, and she "was available to assess and closely follow the nutrition status of the patients" so "similar expertise may not be available at all centers," Ganesan's group cautioned.

Still, they reported that the olanzapine arm had a greater proportion of patients with a weight gain of >5%, along with an improvement in appetite, better quality of life, and nutritional status, but reported less of an impact from chemotoxicity. Olanzapine-related side effects were minimal, although there were some instances of hyperglycemia, but one patient was newly diagnosed with type 2 diabetes during cancer treatment, the researchers said.

They also pointed out that several factors determine food intake, with appetite being one of the key determinants. The proportion of patients achieving >75% intake of recommended daily calories at the end of the study was 52% versus 18% favoring olanzapine.

In the following interview, Ganesan shares more details on the olanzapine-based regimen that he said is used routinely at the JIPMER cancer center to manage chemotherapy-related anorexia.

Based on patient-reported consumption of food and beverages, did you find any difference between the patients on olanzapine and those on placebo in terms of their dietary intake?

Ganesan: Overall, calorie intake was improved with olanzapine. I don't have information about the quality of [each patient's] diet.

Anecdotally, did you observe any difference in treatment effects with olanzapine in the lung cancer patients versus the other patients?

Ganesan: I have not noticed that in my practice at this point. The trial was blinded so we are unable to make any conclusions in this regard. Also the numbers are small in each group for doing subgroup analysis of this sort.

From a psychosocial point of view, did you encounter resistance from patients at the idea of being placed on an antipsychotic agent?

Ganesan: No, we did not face the problem. We have been using olanzapine as standard antiemetic for the last few years anyway.

Do you and your colleagues plan to follow these patients in the long-term for outcomes?

Ganesan: We are following up these patients to look at outcome measures like [disease] progression and survival.

Correction: Article subhead has been updated to emphasize the study's confirmation of olanzapine's effectiveness as an appetite stimulant.

Read the study here.