Predictors of early discontinuation and therapeutic response to anamorelin in patients with cancer cachexia: A retrospective study

OBJECTIVE: Cancer cachexia is associated with poor tolerance to anticancer therapies and reduced survival rates. Anamorelin, a ghrelin receptor agonist, has been introduced for the management of cachexia; however, early discontinuation and variable therapeutic responses are frequently observed in clinical practice. We aimed to identify the real-world predictors of early discontinuation and therapeutic response to anamorelin. MATERIALS AND METHODS: We conducted a retrospective cohort study of 90 patients with cancer cachexia who received anamorelin therapy. Early discontinuation was defined as the cessation of treatment within 3 weeks. Therapeutic response was evaluated using changes in the modified Glasgow Prognostic Score (mGPS) in patients who continued treatment and had evaluable laboratory data. Nutritional and inflammatory indices, including the prognostic nutritional index (PNI), were assessed. Multivariate logistic regression analyses were performed to identify independent predictors. RESULTS: 43 (47.8%) patients discontinued anamorelin treatment within 3 weeks. Multivariate analysis showed that high baseline white blood cell count, low baseline PNI, and gastrointestinal tumor type were independently associated with early discontinuation. Among 38 evaluable patients in the continuation group, 14 (36.8%) demonstrated improvement or stabilization of the mGPS. A high baseline PNI and the absence of concomitant nonsteroidal anti-inflammatory drug use were independently associated with a therapeutic response. CONCLUSION: Baseline nutritional and inflammatory statuses strongly influence both treatment continuation and response to anamorelin. The PNI is a practical predictor for identifying patients who are likely to benefit from therapy. Early intervention before severe nutritional deterioration may optimize the outcomes of patients with cancer cachexia.