&lt;p&gt;Low-dose of olanzapine has ameliorating effects on cancer-related anorexia&lt;/p&gt;

Okamoto, Hideki; Shono, Koyo; Nozaki-Taguchi, Natsuko

doi:10.2147/cmar.s191330

Cited by 17 publications

(16 citation statements)

References 18 publications

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“…OLZ has been used as a model hydrophobic compound for the development of implantable drug delivery systems. Although OLZ is mainly used for the treatment of psychoses and related disorders, such as schizophrenia (National Health Service (NHS), 2021 ), low-dose OLZ can be a promising treatment for other medical conditions such as cancer-related anorexia (Okamoto et al., 2019 ), anorexia nervosa (Dunican & DelDotto, 2007 ; Leggero et al., 2010 ), or acne excoriée (Gupta & Gupta, 2001 ). Moreover, drug dose can be increased by adding more than one implant formulation, as has been previously reported (Karunakaran et al., 2021 ).…”

Section: Resultsmentioning

confidence: 99%

3D-printed implantable devices with biodegradable rate-controlling membrane for sustained delivery of hydrophobic drugs

et al. 2022

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Implantable drug delivery systems offer an alternative for the treatments of long-term conditions (i.e. schizophrenia, HIV, or Parkinson’s disease among many others). The objective of the present work was to formulate implantable devices loaded with the model hydrophobic drug olanzapine (OLZ) using robocasting 3D-printing combined with a pre-formed rate controlling membrane. OLZ was selected as a model molecule due to its hydrophobic nature and because is a good example of a molecule used to treat a chronic condition schizophrenia. The resulting implants consisted of a poly(ethylene oxide) (PEO) implant coated with a poly(caprolactone) (PCL)-based membrane. The implants were loaded with 50 and 80% (w/w) of OLZ. They were prepared using an extrusion-based 3D-printer from aqueous pastes containing 36–38% (w/w) of water. The printing process was carried out at room temperature. The resulting implants were characterized by using infrared spectroscopy, scanning electron microscopy, thermal analysis, and X-ray diffraction. Crystals of OLZ were present in the implant after the printing process. In vitro release studies showed that implants containing 50% and 80% (w/w) of OLZ were capable of providing drug release for up to 190 days. On the other hand, implants containing 80% (w/w) of OLZ presented a slower release kinetics. After 190 days, total drug release was ca. 77% and ca. 64% for implants containing 50% and 80% (w/w) of OLZ, respectively. The higher PEO content within implants containing 50% (w/w) of OLZ allows a faster release as this polymer acts as a co-solvent of the drug.

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Section: Resultsmentioning

confidence: 99%

3D-printed implantable devices with biodegradable rate-controlling membrane for sustained delivery of hydrophobic drugs

et al. 2022

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“…However, we chose the dose of 2.5 mg per day on the basis of data that showed that weight gain is achieved even with lower doses. 16…”

Section: Discussionmentioning

confidence: 99%

Randomized Double-Blind Placebo-Controlled Study of Olanzapine for Chemotherapy-Related Anorexia in Patients With Locally Advanced or Metastatic Gastric, Hepatopancreaticobiliary, and Lung Cancer

Sandhya

Sreenivasan

Goenka

et al. 2023

JCO

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PURPOSE Anorexia occurs in 30%-80% of patients with advanced malignancies, which may be worsened with chemotherapy. This trial assessed the efficacy of olanzapine in stimulating appetite and improving weight gain in patients receiving chemotherapy. METHODS Adults (≥18 years) with untreated, locally advanced, or metastatic gastric, hepatopancreaticobiliary (HPB), and lung cancers were randomly assigned (double-blind) to receive olanzapine (2.5 mg once a day for 12 weeks) or placebo along with chemotherapy. Both groups received standard nutritional assessment and dietary advice. The primary outcomes were the proportion of patients with weight gain > 5% and the improvement in appetite (assessed by the visual analog scale [VAS] and the Functional Assessment of Chronic Illness Therapy system of Quality-of-Life questionnaires Anorexia Cachexia subscale [FAACT ACS]). Secondary end points were change in nutritional status, quality of life (QOL), and chemotherapy toxicity. RESULTS We enrolled 124 patients (olanzapine, 63 and placebo, 61) with a median age of 55 years (18-78 years), of whom 112 (olanzapine, 58 and placebo, 54) were analyzable. The majority (n = 99, 80%) had metastatic cancer (gastric [n = 68, 55%] > lung [n = 43, 35%] > HPB [n = 13, 10%]). The olanzapine arm had a greater proportion of patients with a weight gain of > 5% (35 of 58 [60%] v 5 of 54 [9%], P < .001) and improvement in appetite by VAS (25 of 58 [43%] v 7 of 54 [13%], P < .001) and by FAACT ACS (scores ≥37:13 of 58 [22%] v 2 of 54 [4%], P = .004). Patients on olanzapine had better QOL, nutritional status, and lesser chemotoxicity. Side effects attributable to olanzapine were minimal. CONCLUSION Low-dose, daily olanzapine is a simple, inexpensive, well-tolerated intervention that significantly improves appetite and weight gain in newly diagnosed patients on chemotherapy.

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“…A recent systematic review of olanzapine concluded that while 10 mg/day prophylactic dose is statistically and clinically superior to control CINV, there is paucity of data to support the use of a lower doses (5 mg/day or less) (18). Preliminary studies report olanzapine is also highly effective in treating chronic nausea and vomiting unrelated to chemotherapy (19,20), and may improve appetite and caloric intake in advanced cancer patients (21,22).…”

Section: Discussionmentioning

confidence: 99%

Benefits and risks of off-label olanzapine use for symptom management in cancer patients—a case report

Dev¹,

Fortuno²,

Amaram‐Davila³

et al. 2023

Ann Palliat Med

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Background: Cancer patients often experience symptoms such as anorexia, anxiety and insomnia, which can impact their quality of life. Randomized placebo-controlled trials support prophylactic use of olanzapine for the prevention of nausea and vomiting due to moderate and high-emetic risk chemotherapy. In the setting of palliative care, olanzapine is increasingly utilized as an off-label treatment of symptoms including anorexia-cachexia, anxiety, and insomnia. The following case reports will highlight the potential benefits and risks of off-label olanzapine use for symptom management in cancer patients.Case Description: Patient 1 is a female in her 70s with stage IV infiltrating ductal carcinoma of the right breast was having trouble tolerating treatment with letrozole, palbociclib, and denosumab due to uncontrolled nausea resulting in weight loss. Her nausea was refractory to multiple anti-emetics. Low dose olanzapine (2.5 mg) prevented nausea and allowed her to tolerate treatment. Patient 2 is a male in his 50s with renal cell carcinoma, who was receiving treatment with cabozantinib, presented with uncontrolled pain improved with opioid rotation from oxycodone to morphine. He was also experiencing uncontrolled anxiety despite treatment with alprazolam. Alprazolam was weaned and replaced with olanzapine resulting in improvement of his symptoms. Patient 3 is a male in his 60s with pancreatic adenocarcinoma who presented with muscle weakness and fatigue resulting in discontinuation of gemcitabine plus cisplatin. He also had symptoms of depression, poor appetite, and sleep problems. He was prescribed short course of dexamethasone 4 mg by mouth twice daily and olanzapine 5 mg by mouth nightly to improve symptoms.One week after, he presented with confusion and workup revealed hyperammonia which was treated with lactulose, which led to the return of baseline mentation.Conclusions: Olanzapine antagonizes multiple receptors and has potential to treat a host of symptoms including nausea, anorexia, anxiety, and insomnia, but healthcare providers should be mindful of potential risks and unclear benefits for off-label indications. More research and funding are needed evaluating off-label use of olanzapine for palliation of symptoms in cancer patients who are often frail and susceptible to adverse events.

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<p>Low-dose of olanzapine has ameliorating effects on cancer-related anorexia</p>

Cited by 17 publications

References 18 publications

3D-printed implantable devices with biodegradable rate-controlling membrane for sustained delivery of hydrophobic drugs

3D-printed implantable devices with biodegradable rate-controlling membrane for sustained delivery of hydrophobic drugs

Randomized Double-Blind Placebo-Controlled Study of Olanzapine for Chemotherapy-Related Anorexia in Patients With Locally Advanced or Metastatic Gastric, Hepatopancreaticobiliary, and Lung Cancer

Benefits and risks of off-label olanzapine use for symptom management in cancer patients—a case report

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