Cachexia is estimated to be the immediate cause of death in 20% to 40% of cancer patients,” and by the time of diagnosis, “60% of patients with lung cancer have already experienced a significant weight loss, according to the National Cancer Institute.1
“All of us who have treated these patients have tried many things, with very limited success,” noted Philip Bonomi, MD, Director of the Division of Hematology/Oncology at Rush and Alice Pirie Wirtz Professor of Medicine at Rush University Medical Center. He is also the lead author of ROMANA 1, a phase III study showing that the investigational agent anamorelin hydrochloride significantly increased weight and lean body mass and significantly improved anorexia-cachexia symptoms among patients with unresectable stage III/IV non–small cell lung cancer (NSCLC).2
Often, Dr. Bonomi noted, it the patient’s family members who express the most concern about the patient not eating, leaving the patient to grapple with physiologic reasons for not eating and the added pressure from family members to eat. In the functional assessment portion of the ROMANA 1 trial, patients reported improvements in appetite and less pressure from family members to eat. Patients randomized to receive anamorelin had a median increase of 1.10 kg in lean body mass and of 2.20 kg in body weight.
So Few Alternatives
Current treatment for cachexia has very limited efficacy and is associated with potential risks. The side effects of glucocorticoids “are not minor,” Dr. Bonomi said. “You’re trying to make somebody feel stronger, and one of the major side effects of those drugs is proximal muscle weakness.” This can affect hips and thigh, “so getting out of a chair, getting out of a low car, lifting your leg to go up a stair, those are profoundly weakened in some patients.”
None of the progestational agents “works very well. There is not a head-to-head comparison, but in my experience, they don’t,” Dr. Bonomi stated.
Cannabis “may help some people but is not especially good either,” he added. “There really isn’t a good choice for these patients.”
Other Potential Uses
In addition to combating cachexia, anamorelin has other potential uses, Dr. Bonomi reported. People with “any disease associated with wasting” might benefit, he said. A major indication would be for chronic obstructive pulmonary disease. Other indications may include serious rheumatoid arthritis, chronic renal disease, and conditions related to aging.
“There are many potential places where this could help,” he said, “but it probably has to be in conjunction with [physical] training.” ■
Disclosure: Dr. Bonomi reported no potential conflicts of interest.
References
1. Nutrition in Cancer (PFQ®) Health Professional Version. National Cancer Institute. Last modified September 9, 2104.
2. Bonomi P, Temel J, Currow D, et al: Anamorelin for the treatment of cancer anorexia-cachexia in advanced NSCLC: Results from ROMANA 1, a pivotal phase 3 study. 2014 Chicago Multidisciplinary Symposium in Thoracic Oncology. Abstract 5. Presented October 31, 2014.
