Asenapine for delirium in patients with cancer: A scoping review

This scoping review mapped the existing literature on the application of asenapine for delirium management in patients with cancer, including prevention and treatment, while summarizing current research trends. The review followed the methodological framework proposed by Arksey and O'Malley and was reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews. PubMed and Ichushi-Web were searched on June 30, 2025, using the keywords "asenapine," "delirium," and "cancer." Eligible studies included reports on asenapine management for delirium in patients with cancer. Two reviewers independently screened records and extracted data. Among the six records identified, three studies met the inclusion criteria and were included in this review. Two of these were retrospective observational studies, and one was a case report. One retrospective study described six terminally ill patients treated with sublingual asenapine, showing marked improvement in agitation, as measured using the Richmond Agitation-Sedation Scale. The other study analyzed 20 patients with advanced cancer and reported reductions in the Agitation Distress Scale scores, particularly among those with poor performance status. Moreover, this case report highlighted the successful use of sublingual asenapine in a patient with aphagia unresponsive to other antipsychotic agents. Across the studies, asenapine was generally well-tolerated, with one suspected dysarthria and no serious adverse events. The current evidence is limited in quantity and quality, and no preventive studies were identified. While preliminary findings suggest that sublingual asenapine may be useful and well-tolerated for treating delirium in patients with cancer, further high-quality studies are warranted.