Cancer-related nausea and vomiting are among the most distressing symptoms in palliative-care patients, severely impairing quality of life and oral intake. In terminal gastric cancer, multifactorial mechanisms often render symptoms refractory. In patients with metoclopramide allergy, the limitation of standard antiemetic options further complicates symptom management.A 40-year-old woman with asthma and signet-ring cell gastric carcinoma was admitted to a family physician–led palliative care unit because of severe vomiting and complete loss of oral intake. Her quality of life had deteriorated. She also had dyspnea and abdominal distension. Laboratory tests were hemoglobin 9.9 g/dL, creatinine 2.84 mg/dL, sodium 132 mmol/L, and CRP 28 mg/L. Imaging revealed pleural effusion and ascites. Pleural catheter placement and paracentesis were performed. Acute kidney injury was considered post-renal and resolved after drainage and supportive care. Despite granisetron, proton pump inhibitors, and antacid therapy, nausea and vomiting persisted. Metoclopramide could not be used because of allergy.After renal function normalized and infection markers were closely monitored, a short course of methylprednisolone was started, and olanzapine was added. Although olanzapine is mainly known for anxiolytic and antipsychotic effects, it is effective in nausea and vomiting through dopaminergic, serotonergic, and histaminergic pathways. This combination resulted in rapid and complete resolution of vomiting. Oral intake was restored, and the patient was able to eat her favorite foods during the final period of her life.In terminal cancer patients with refractory nausea and vomiting, short-term corticosteroids combined with olanzapine may be considered when infection parameters and organ function are carefully monitored. Olanzapine may also reduce cancer-related anxiety, providing dual benefit. Early control of ascites and pleural effusion improves antiemetic response.Previous studies report that olanzapine is effective in refractory nausea and vomiting in palliative and oncology settings. Corticosteroids have also been shown to enhance symptom control by reducing inflammation and visceral edema. The clinical response in this case is consistent with the existing literature.In this terminal gastric cancer case, refractory nausea unresponsive to standard therapy was successfully controlled with olanzapine and short-course methylprednisolone. Individualized pharmacological treatment in palliative care supports comfort, dignity, and humanity at the end of life.