OnCo
ideasIdea

A cheap old tablet to restore appetite

A low dose of an old, inexpensive tablet improved appetite and weight in a randomised trial of people with advanced cancer. It could be used almost everywhere tomorrow.

Low-dose olanzapine, at 2.5 mg daily, improved appetite, weight gain and quality of life versus placebo in a randomised trial in patients with advanced gastrointestinal and lung cancer receiving chemotherapy, conducted at Tata Memorial. The drug is generic, oral, off-patent and already used for chemotherapy-induced nausea, so implementation requires guideline change rather than development.

Hypothesis
Low-dose olanzapine as standard supportive care for cancer-related anorexia improves weight, appetite and chemotherapy completion rates in routine practice, replicating the trial result at population scale.
Rationale
The mechanism, appetite stimulation with a favourable metabolic profile at low dose, is well established in psychiatry, and the drug already appears in antiemetic guidelines so safety monitoring is familiar. Cost is negligible in almost every health system.
What would test it
Run a pragmatic multi-country replication trial, particularly in low- and middle-income settings, with appetite, weight, quality of life and metabolic adverse events as endpoints; then guideline adoption.
Maturity
early clinical
Who has to act
clinic
Cost to try
Small (under $1M)
Years to first evidence
3
Bottlenecks it attacks

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