Olanzapine for Managing Side Effects From Antiangiogenic Tyrosine-Kinase Inhibitors
Side effects from tyrosine kinase inhibitors (TKIs) are common and burdensome. Olanzapine is useful for managing symptoms from conventional chemotherapy, but its role in treating TKI-related side effects is unclear. Examine the efficacy of olanzapine for TKI-induced nausea, vomiting, anorexia, weigh...
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| Published in | Journal of pain and symptom management Vol. 70; no. 2; pp. 182 - 188 |
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| Main Authors | , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
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United States
Elsevier Inc
01.08.2025
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| Abstract | Side effects from tyrosine kinase inhibitors (TKIs) are common and burdensome. Olanzapine is useful for managing symptoms from conventional chemotherapy, but its role in treating TKI-related side effects is unclear.
Examine the efficacy of olanzapine for TKI-induced nausea, vomiting, anorexia, weight loss, and insomnia.
All patients prescribed olanzapine with lenvatinib, cabozantinib, axitinib, or tivozanib at Mayo Clinic between January 2018 and June 2024 were assessed for inclusion. For baseline assessment, clinical notes documenting symptoms and indication(s) for starting olanzapine were reviewed. Notes and portal messages from the first three months after starting olanzapine were then evaluated for qualitative descriptions of change in symptom burden. Data were categorized as “improved,” “worsened,” “stable,” or “missing data,” with each symptom domain analyzed independently, when olanzapine was prescribed for multiple interrelated symptoms.
Sixty patients received olanzapine, most commonly 5 mg (n = 37, 61.7%) or 2.5 mg (n = 16, 26.6%). Indications included nausea without vomiting (n = 35), anorexia (n = 25), nausea with vomiting (n = 16), weight loss (n = 16), and insomnia (n = 11). It was given for multiple symptoms in 32 patients. Within the first 3 months, 85% of patients had improvement in nausea without vomiting, 93% in nausea with vomiting, 74% in appetite, and 85% in sleep. Among 34 patients with weight loss prior to olanzapine, 50% gained weight (median: 6.1 kg), 26% stabilized (±1 kg), and 24% continued to lose weight. Only 4 patients discontinued olanzapine due to side effects.
Olanzapine appears effective in treating TKI-induced nausea, vomiting, anorexia, insomnia, and weight loss, warranting further investigation in prospective studies. |
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| AbstractList | Side effects from tyrosine kinase inhibitors (TKIs) are common and burdensome. Olanzapine is useful for managing symptoms from conventional chemotherapy, but its role in treating TKI-related side effects is unclear.
Examine the efficacy of olanzapine for TKI-induced nausea, vomiting, anorexia, weight loss, and insomnia.
All patients prescribed olanzapine with lenvatinib, cabozantinib, axitinib, or tivozanib at Mayo Clinic between January 2018 and June 2024 were assessed for inclusion. For baseline assessment, clinical notes documenting symptoms and indication(s) for starting olanzapine were reviewed. Notes and portal messages from the first three months after starting olanzapine were then evaluated for qualitative descriptions of change in symptom burden. Data were categorized as “improved,” “worsened,” “stable,” or “missing data,” with each symptom domain analyzed independently, when olanzapine was prescribed for multiple interrelated symptoms.
Sixty patients received olanzapine, most commonly 5 mg (n = 37, 61.7%) or 2.5 mg (n = 16, 26.6%). Indications included nausea without vomiting (n = 35), anorexia (n = 25), nausea with vomiting (n = 16), weight loss (n = 16), and insomnia (n = 11). It was given for multiple symptoms in 32 patients. Within the first 3 months, 85% of patients had improvement in nausea without vomiting, 93% in nausea with vomiting, 74% in appetite, and 85% in sleep. Among 34 patients with weight loss prior to olanzapine, 50% gained weight (median: 6.1 kg), 26% stabilized (±1 kg), and 24% continued to lose weight. Only 4 patients discontinued olanzapine due to side effects.
Olanzapine appears effective in treating TKI-induced nausea, vomiting, anorexia, insomnia, and weight loss, warranting further investigation in prospective studies. Side effects from tyrosine kinase inhibitors (TKIs) are common and burdensome. Olanzapine is useful for managing symptoms from conventional chemotherapy, but its role in treating TKI-related side effects is unclear.CONTEXTSide effects from tyrosine kinase inhibitors (TKIs) are common and burdensome. Olanzapine is useful for managing symptoms from conventional chemotherapy, but its role in treating TKI-related side effects is unclear.Examine the efficacy of olanzapine for TKI-induced nausea, vomiting, anorexia, weight loss, and insomnia.OBJECTIVESExamine the efficacy of olanzapine for TKI-induced nausea, vomiting, anorexia, weight loss, and insomnia.All patients prescribed olanzapine with lenvatinib, cabozantinib, axitinib, or tivozanib at Mayo Clinic between January 2018 and June 2024 were assessed for inclusion. For baseline assessment, clinical notes documenting symptoms and indication(s) for starting olanzapine were reviewed. Notes and portal messages from the first three months after starting olanzapine were then evaluated for qualitative descriptions of change in symptom burden. Data were categorized as "improved," "worsened," "stable," or "missing data", with each symptom domain analyzed independently, when olanzapine was prescribed for multiple interrelated symptoms.METHODSAll patients prescribed olanzapine with lenvatinib, cabozantinib, axitinib, or tivozanib at Mayo Clinic between January 2018 and June 2024 were assessed for inclusion. For baseline assessment, clinical notes documenting symptoms and indication(s) for starting olanzapine were reviewed. Notes and portal messages from the first three months after starting olanzapine were then evaluated for qualitative descriptions of change in symptom burden. Data were categorized as "improved," "worsened," "stable," or "missing data", with each symptom domain analyzed independently, when olanzapine was prescribed for multiple interrelated symptoms.Sixty patients received olanzapine, most commonly 5 mg (n=37, 61.7%) or 2.5 mg (n=16, 26.6%). Indications included nausea without vomiting (n=35), anorexia (n=25), nausea with vomiting (n=16), weight loss (n=16), and insomnia (n=11). It was given for multiple symptoms in 32 patients. Within the first 3 months, 85% of patients had improvement in nausea without vomiting, 93% in nausea with vomiting, 74% in appetite, and 85% in sleep. Among 34 patients with weight loss prior to olanzapine, 50% gained weight (median: 6.1 kg), 26% stabilized (±1 kg), and 24% continued to lose weight. Only 4 patients discontinued olanzapine due to side effects.RESULTSSixty patients received olanzapine, most commonly 5 mg (n=37, 61.7%) or 2.5 mg (n=16, 26.6%). Indications included nausea without vomiting (n=35), anorexia (n=25), nausea with vomiting (n=16), weight loss (n=16), and insomnia (n=11). It was given for multiple symptoms in 32 patients. Within the first 3 months, 85% of patients had improvement in nausea without vomiting, 93% in nausea with vomiting, 74% in appetite, and 85% in sleep. Among 34 patients with weight loss prior to olanzapine, 50% gained weight (median: 6.1 kg), 26% stabilized (±1 kg), and 24% continued to lose weight. Only 4 patients discontinued olanzapine due to side effects.Olanzapine appears effective in treating TKI-induced nausea, vomiting, anorexia, insomnia, and weight loss, warranting further investigation in prospective studies.CONCLUSIONOlanzapine appears effective in treating TKI-induced nausea, vomiting, anorexia, insomnia, and weight loss, warranting further investigation in prospective studies. AbstractContextSide effects from tyrosine kinase inhibitors (TKIs) are common and burdensome. Olanzapine is useful for managing symptoms from conventional chemotherapy, but its role in treating TKI-related side effects is unclear. ObjectivesExamine the efficacy of olanzapine for TKI-induced nausea, vomiting, anorexia, weight loss, and insomnia. MethodsAll patients prescribed olanzapine with lenvatinib, cabozantinib, axitinib, or tivozanib at Mayo Clinic between January 2018 and June 2024 were assessed for inclusion. For baseline assessment, clinical notes documenting symptoms and indication(s) for starting olanzapine were reviewed. Notes and portal messages from the first three months after starting olanzapine were then evaluated for qualitative descriptions of change in symptom burden. Data were categorized as “improved,” “worsened,” “stable,” or “missing data,” with each symptom domain analyzed independently, when olanzapine was prescribed for multiple interrelated symptoms. ResultsSixty patients received olanzapine, most commonly 5 mg ( n = 37, 61.7%) or 2.5 mg ( n = 16, 26.6%). Indications included nausea without vomiting ( n = 35), anorexia ( n = 25), nausea with vomiting ( n = 16), weight loss ( n = 16), and insomnia ( n = 11). It was given for multiple symptoms in 32 patients. Within the first 3 months, 85% of patients had improvement in nausea without vomiting, 93% in nausea with vomiting, 74% in appetite, and 85% in sleep. Among 34 patients with weight loss prior to olanzapine, 50% gained weight (median: 6.1 kg), 26% stabilized (±1 kg), and 24% continued to lose weight. Only 4 patients discontinued olanzapine due to side effects. ConclusionOlanzapine appears effective in treating TKI-induced nausea, vomiting, anorexia, insomnia, and weight loss, warranting further investigation in prospective studies. |
| Author | Heath, Elisabeth I. Spychalla, Megan T. Peskey, Candy S. Childs, Daniel S. Quevedo, Fernando Koch, Regina M. Zakharia, Yousef Ruddy, Kathryn J. D’Andre, Stacy D. Muniz, Miguel Costello, Brian A. Loprinzi, Charles L. Cathcart-Rake, Elizabeth J. Jatoi, Aminah Orme, Jacob J. Riaz, Irbaz B. Sartor, Oliver Pagliaro, Lance C. Singh, Parminder |
| Author_xml | – sequence: 1 givenname: Regina M. orcidid: 0000-0001-6618-6862 surname: Koch fullname: Koch, Regina M. email: koch.regina@mayo.edu organization: Department of Internal Medicine (R.M.K.,), Mayo Clinic, Rochester, Minnesota, USA – sequence: 2 givenname: Miguel orcidid: 0009-0004-7268-5077 surname: Muniz fullname: Muniz, Miguel organization: Department of Medical Oncology (M.M., C.S.P., A.J., K.J.R., J.J.O., L.C.P., F.Q., B.A.C., M.T.S., E.I.H., O.S., E.J.C.R., S.D.D.A, C.L.L., D.S.C.), Mayo Clinic, Rochester, Minnesota, USA – sequence: 3 givenname: Candy S. orcidid: 0009-0005-0271-5274 surname: Peskey fullname: Peskey, Candy S. organization: Department of Medical Oncology (M.M., C.S.P., A.J., K.J.R., J.J.O., L.C.P., F.Q., B.A.C., M.T.S., E.I.H., O.S., E.J.C.R., S.D.D.A, C.L.L., D.S.C.), Mayo Clinic, Rochester, Minnesota, USA – sequence: 4 givenname: Aminah orcidid: 0000-0002-1081-189X surname: Jatoi fullname: Jatoi, Aminah organization: Department of Medical Oncology 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C.L.L., D.S.C.), Mayo Clinic, Rochester, Minnesota, USA – sequence: 8 givenname: Fernando surname: Quevedo fullname: Quevedo, Fernando organization: Department of Medical Oncology (M.M., C.S.P., A.J., K.J.R., J.J.O., L.C.P., F.Q., B.A.C., M.T.S., E.I.H., O.S., E.J.C.R., S.D.D.A, C.L.L., D.S.C.), Mayo Clinic, Rochester, Minnesota, USA – sequence: 9 givenname: Brian A. surname: Costello fullname: Costello, Brian A. organization: Department of Medical Oncology (M.M., C.S.P., A.J., K.J.R., J.J.O., L.C.P., F.Q., B.A.C., M.T.S., E.I.H., O.S., E.J.C.R., S.D.D.A, C.L.L., D.S.C.), Mayo Clinic, Rochester, Minnesota, USA – sequence: 10 givenname: Megan T. surname: Spychalla fullname: Spychalla, Megan T. organization: Department of Medical Oncology (M.M., C.S.P., A.J., K.J.R., J.J.O., L.C.P., F.Q., B.A.C., M.T.S., E.I.H., O.S., E.J.C.R., S.D.D.A, C.L.L., D.S.C.), Mayo Clinic, Rochester, Minnesota, USA – sequence: 11 givenname: Elisabeth I. orcidid: 0000-0003-1381-2713 surname: Heath fullname: Heath, Elisabeth I. organization: Department of Medical Oncology (M.M., C.S.P., A.J., K.J.R., J.J.O., L.C.P., F.Q., B.A.C., M.T.S., E.I.H., O.S., E.J.C.R., S.D.D.A, C.L.L., D.S.C.), Mayo Clinic, Rochester, Minnesota, USA – sequence: 12 givenname: Yousef surname: Zakharia fullname: Zakharia, Yousef organization: Division of Hematology and Medical Oncology (Y.Z., P.S., I.B.R.), Mayo Clinic, Scottsdale, Arizona, USA – sequence: 13 givenname: Parminder orcidid: 0000-0002-8548-6948 surname: Singh fullname: Singh, Parminder organization: Division of Hematology and Medical Oncology (Y.Z., P.S., I.B.R.), Mayo Clinic, Scottsdale, Arizona, USA – sequence: 14 givenname: Oliver orcidid: 0000-0002-8777-7343 surname: Sartor fullname: Sartor, Oliver organization: Department of Medical Oncology (M.M., C.S.P., A.J., K.J.R., J.J.O., L.C.P., F.Q., B.A.C., M.T.S., E.I.H., O.S., E.J.C.R., S.D.D.A, C.L.L., D.S.C.), Mayo Clinic, Rochester, Minnesota, USA – sequence: 15 givenname: Irbaz B. surname: Riaz fullname: Riaz, Irbaz B. organization: Division of Hematology and Medical Oncology (Y.Z., P.S., I.B.R.), Mayo Clinic, Scottsdale, Arizona, USA – sequence: 16 givenname: Elizabeth J. surname: Cathcart-Rake fullname: Cathcart-Rake, Elizabeth J. organization: Department of Medical Oncology (M.M., C.S.P., A.J., K.J.R., J.J.O., L.C.P., F.Q., B.A.C., M.T.S., E.I.H., O.S., E.J.C.R., S.D.D.A, C.L.L., D.S.C.), Mayo Clinic, Rochester, Minnesota, USA – sequence: 17 givenname: Stacy D. surname: D’Andre fullname: D’Andre, Stacy D. organization: Department of Medical Oncology (M.M., C.S.P., A.J., K.J.R., J.J.O., L.C.P., F.Q., B.A.C., M.T.S., E.I.H., O.S., E.J.C.R., S.D.D.A, C.L.L., D.S.C.), Mayo Clinic, Rochester, Minnesota, USA – sequence: 18 givenname: Charles L. orcidid: 0000-0001-8044-5752 surname: Loprinzi fullname: Loprinzi, Charles L. organization: Department of Medical Oncology (M.M., C.S.P., A.J., K.J.R., J.J.O., L.C.P., F.Q., B.A.C., M.T.S., E.I.H., O.S., E.J.C.R., S.D.D.A, C.L.L., D.S.C.), Mayo Clinic, Rochester, Minnesota, USA – sequence: 19 givenname: Daniel S. orcidid: 0000-0001-7643-2836 surname: Childs fullname: Childs, Daniel S. organization: Department of Medical Oncology (M.M., C.S.P., A.J., K.J.R., J.J.O., L.C.P., F.Q., B.A.C., M.T.S., E.I.H., O.S., E.J.C.R., S.D.D.A, C.L.L., D.S.C.), Mayo Clinic, Rochester, Minnesota, USA |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/40324698$$D View this record in MEDLINE/PubMed |
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| Copyright | 2025 American Academy of Hospice and Palliative Medicine American Academy of Hospice and Palliative Medicine Copyright © 2025 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved. Copyright © 2025. Published by Elsevier Inc. |
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| Keywords | tyrosine kinase inhibitors weight loss Olanzapine anorexia nausea insomnia |
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| Snippet | Side effects from tyrosine kinase inhibitors (TKIs) are common and burdensome. Olanzapine is useful for managing symptoms from conventional chemotherapy, but... AbstractContextSide effects from tyrosine kinase inhibitors (TKIs) are common and burdensome. Olanzapine is useful for managing symptoms from conventional... |
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| Title | Olanzapine for Managing Side Effects From Antiangiogenic Tyrosine-Kinase Inhibitors |
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