To determine whether olanzapine or mirtazapine is more effective in preventing weight loss and appetite loss in cancer patients.

Olanzapine and Mirtazapine have been used in the past few years to attempt to prevent weight and appetite loss in cancer patients. Both have mixed study results and none of the previous studies are of high enough quality to make clinical recommendations. With limited options available, palliative and oncology providers turn to these medications with little evidence. There are no formal studies comparing the two to determine if one is superior to the other, so choices are often made based purely on provider preference. We aim to conduct a study to determine if one of the drugs outperforms the other to guide our standard practice at Englewood Health. This study is being conducted to determine whether olanzapine or mirtazapine is more effective in preventing weight loss and appetite loss in cancer patients.

Inclusion Criteria:

• • 18 years of age or older

  • Able to provide informed consent

  • Pathologically and/or clinically confirmed diagnosis of advanced cancer

  • At any point of treatment with standard chemotherapy*

    o Scheduled to start, have discontinued or completed, or currently receiving

  • Greater than or equal to 5% unintentional weight loss over the previous 3-6 months, not explained by simple starvation

    o Simple starvation is considered to be excluded when weight loss is not ameliorated by standard nutritional counseling and oral supplementation over a 2-week period).

  • Life expectancy of at least 4 months

  • Able to communicate well and comply with study requirements, including by phone and written logs

    • Patients on Dexamethasone will be allowed

Exclusion Criteria:

• • Abnormal liver function defined as > twice upper limit of normal

  • Elevated QTc

    o EKG performed within 1 year of enrollment will be accepted

  • Total parental nutrition (TPN) or enteral feeds (PEG/PEJ) for >70% of their primary source of daily calorie intake

  • Taking Marinol within 2 week of enrollment onto study