Anamorelin for the Treatment of Cancer Anorexia- Cachexia Syndrome of Lung Cancer

Review Article

Austin J Lung Cancer Res. 2016; 1(1): 1001.

Anamorelin for the Treatment of Cancer Anorexia- Cachexia Syndrome of Lung Cancer

Hidefumi Sasaki*

Department of Oncology, Nagoya City University Graduate School of Medical Sciences, Japan

*Corresponding author: Hidefumi Sasaki, Global Medical Services, PAREXEL International, Tokyo, Japan

Received: November 17, 2015; Accepted: December 18, 2015; Published: January 04, 2016

Abstract

Anorexia and cachexia are among the most troubling and distressing symptoms of advanced cancer, for both patients and their families. Cancer anorexia-cachexia syndrome is a common debilitating condition, characterized by decreased body weight, mainly lean body mass and negatively impacts quality of life and prognosis. The condition is very common in patients with advanced lung cancer. Anamorelin HCl is a novel selective ghrelin receptor agonist with appetite-enhancing and anabolic activity. Anamorelin aims to address the symptoms by mimicking the effects of the so-called “hunger hormone” ghrelin, which is secreted by the stomach. The large, randomized controlled ROMANA 1 and 2 trials are the first phase III studies examining the impact of anamorelin on anorexia-cachexia in patients with advanced lung cancer.

Keywords: Cachexia; Anamorelin; Lung Cancer

Introduction

Alterations in body constructions that happen with chronic diseases are normally considered unwanted and are associated with loss of appetite, substantial weight loss, dramatic muscle loss and general weakness [1,2]. Thus the metabolic disorder, body overzealously breaks down skeletal muscle and adipose tissue may be associated with weight loss. Such unconscious weight loss has been termed cachexia. For example, cancer cells produce chemicals or other products that cause cachexia. Cachexia involves multiple pathways: procachectic and proinflammatory signals from cancer cells, systemic inflammation host and widespread changes. Cancer Anorexia-Cachexia Syndrome (CACS) was recently defined by an international expert consensus group as ‘‘amultifractorial syndrome characterized by an ongoing loss of skeletal mass (with or without loss of fat mass) that cannot be fully reversed by conventional support and leads to progressive functional impairment’’ [3]. CACS has severe consequences, such as reduction of treatment tolerance, reduction of response to therapy, and shortened survival, and can adversely affect a person’s quality of life [3-8]. Increased resting energy expenditure and alterations in metabolism of protein, fat, and carbohydrate are the reason for metabolic changes in cancer patients. Over expression of proinflammatory cytokines, such as Interleukin (IL)-1, IL-6, tumor necrosis factor, or interferon-γ, TNF-a, TGF-β, as well as macrophage inhibitory cytokine-1/growth differentiation factor 15 (MIC-1/GDF- 15) appear to be involved [9,10]. Inflammatory processes have been shown to maintain the wasting process in cachexia. Understanding the complex interplay of tumor and host factors will uncover new therapeutic targets. Activation of these factors has effects on peripheral (lipolysis, proteolysis, insulin resistance) as well as on central pathways (hypothalamic appetite regulation) [9,11] (Figure 1).

Citation: Sasaki H. Anamorelin for the Treatment of Cancer Anorexia-Cachexia Syndrome of Lung Cancer. Austin J Lung Cancer Res. 2016; 1(1): 1001.