Olanzapine for the Management of Cancer Associated Appetite Loss in Patients With Advanced and Incurable Solid Tumors

This phase II trial tests how well olanzapine may work in managing cancer cachexia in patients experiencing advanced solid tumor cancer-associated appetite loss while receiving non-curative cancer therapy. Loss of appetite ("anorexia") in the setting of cancer is a key feature of "cachexia," a syndrome associated with loss of weight and muscle as well as weakness and fatigue. Olanzapine is a type of drug that targets key neurotransmitters (a type of molecule used by the brain to transmit messages to the rest of the body) that may stimulate appetite, restore caloric intake, minimize weight loss, and improve quality of life.

Inclusion Criteria:Willingness to provide written informed consent. For decisional impairment or conditions that render the individual unable to independently provide consent, a legally authorized representative must be available or designated in conjunction with the study consent processIndividuals >= 18 years of age of all races, ethnicities, sexual orientations, gender identities, and abilities may be screened for enrollment without biasHistologically confirmed advanced and incurable solid tumor cancer diagnosis within 12 weeks of screening. Cancer diagnoses will include those for which standard curative measures do not exist or are no longer effectivePlanned or ongoing standard of care (SOC) systemic antineoplastic therapy without curative intent (concurrent to this study)Able to ambulate independently with or without assistive devices (e.g., cane, walker).In the case of brain metastases, the individual must be asymptomatic or previously treated with a full cycle of therapy such that recovery from any acute effects of radiation therapy or surgery has occurred before the screening. Such individuals must have discontinued corticosteroid treatment and be neurologically stable for at least 4 weeks before screeningEastern Cooperative Oncology Group (ECOG) performance status of 0-2Able and willing to discontinue the use of any drug or over-the-counter (OTC) product that may interact with the study drug (within a period sufficient for wash-out per the investigator's discretion) and thereafter while on the studyWillingness to comply with restrictions on chest/breastfeedingIndividuals capable of childbearing and contributing viable sperm must be willing to comply with contraception requirements and not donate ova or sperm while on the study and for 1 month after thatA negative pregnancy test at baseline must be obtained for individuals capable of childbearingExclusion Criteria:Plan for, or history of (within 30 days of registration), the use of an antipsychotic drug, including, but not limited to risperidone, quetiapine, clozapine, phenothiazine, or butyrophenone. This limitation does not include prochlorperazine and other phenothiazines as antiemetic therapy. The use of antipsychotics concurrent with protocol therapy will not be allowedPrevious or current use of megestrol acetate, cannabinoids (including, but not limited to dronabinol, medical cannabis, over the counter [OTC] cannabinoids products), and/or corticosteroids (defined as >= 5mg of prednisone or equivalent per day, except for standard chemotherapy-induced nausea and vomiting [CINV] prophylaxis) during the proceeding >=14 daysKnown history of poorly controlled diabetes, defined as fasting morning blood sugars > 300 mg/dL or recent hemoglobin A1c >= 8Inadequate organ function, which may include, but is not limited to, the following laboratory results within 28 days before signing consent:Total bilirubin > upper limit of normal (ULN), aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SPGT]) > 2.5 ULN (unless the participant has documented Gilbert's syndrome, hepatocellular carcinoma, or hepatic metastases)Serum creatinine > 2.0 mg/dL or calculated glomerular filtration rate (GFR) >= 30 mL/minute/1.73 m^2 as calculated by the modification of diet in renal disease (MDRD) equationNOTE: Investigator discretion will determine continued eligibility after randomization occurs in the event the liver function test results are greater than (>) the proposed upper limit of normalTube feeding or parenteral nutrition at the time of screeningAny condition that may negatively impact oral absorption of the study drug (including, but not limited to dysphagia, mucositis, gastrectomy, colitis, bowel obstruction, high output ileostomy) or any plan to undergo an intervention that will render such a conditionRecurrent ascites unresponsive to medical interventions and requires therapeutic paracentesisUncontrolled symptoms (including, but not limited to, pain and nausea) at randomization make the individual unsuitable for the study in the judgment of the principal investigator (PI). If uncontrolled symptoms can be effectively palliated for >= 1 week prior, enrollment may be considered at the discretion of the PIUncontrolled infection, including coronavirus disease 2019 (COVID-19), at time of randomization. Individuals with the uncontrolled infection will not be eligible as the symptomology of infection may obscure the outcomes of this studyOther medical or psychiatric condition, including recent (within 1 year) or active suicidal ideation/behavior or laboratory abnormality, may increase the risk of study participation or, in the investigator's judgment, makes the participant inappropriate for the study