PUDUCHERRY: Cancer treatment continues to be painful and costly despite major advances in oncolgy. Patients undergoing chemotherapy often experience severe weight loss with lower food intake. A path-breaking trial conducted at JIPMER offers an effective low-cost remedy to this issue. The trial found that an antipsychotic drug can combat severe appetite loss in patients undergoing chemotherapy. This research, spearheaded by Principal Investigator Dr Prasanth Ganesan, Professor of Medical Oncology, found success with Olanzapine, primarily an antipsychotic drug, costing a mere ₹2 per day.
Its efficacy, coupled with affordability, heralds a new chapter in managing appetite loss in cancer patients. According to JIPMER, this has garnered international recognition and prompted alterations in the recommendations set forth by the American Society of Clinical Oncology for managing anorexia in chemotherapy recipients. Anorexia, an issue affecting 30% to 80% of individuals grappling with advanced malignancies, compromises nutritional status of the patient and may indirectly worsen chemotherapy tolerance and thus survival.
The recent trial’s focus on low-dose daily olanzapine, demonstrated promising outcomes, proving to be a simple, inexpensive, and well-tolerated intervention significantly improving appetite and promoting weight gain in newly diagnosed patients undergoing chemotherapy, said Dr Prasanth.
The study found that 40% to 60% of newly diagnosed cancer patients experience anorexia, which, when coupled with insufficient oral intake, can detrimentally impact cancer survival rates. Chemotherapy tends to worsen anorexia, compromising nutritional statuses and indirectly affecting treatment tolerance and cancer-related outcomes, particularly in certain cancers such as gastrointestinal tract and lung cancers.
Conventional guidelines for managing anorexia and cachexia primarily advocate dietary counseling, with limited data supporting the use of pharmacological agents to stimulate (Cachexia is the weakness and wasting of the body due to severe chronic illness.)
What is Olanzapine
Olanzapine, affecting dopamine and serotonin receptors, was initially known for causing weight gain in schizophrenia patients. It has now gained attention for its potential to stimulate appetite.The trial commencing from the first day of chemotherapy and continuing for 12 weeks involved administering olanzapine alongside nutritional advice to patients with advanced lung, gastric, and hepatopancreatic biliary tract cancers.
A total of 150 patients were screened between November 2020 and June 2022, with 124 enrolled in the trial (63 in olanzapine arm and 61 in the placebo arm). Of these, 58 in the olanzapine group and 54 in the placebo group were evaluated for the primary endpoint of weight gain at the 12-week mark.
The results revealed a significant disparity, with 60% (35 out of 58 patients) in the olanzapine group achieving over 5% weight gain, while only 9% (5 out of 54 patients) in the placebo group experienced similar results. Additionally, the proportion of patients suffering from weight loss at the study’s conclusion was lower among those treated with olanzapine (14% vs 59%).