Ogura Miki, Matsuoka Hiroshi, Shinohara Saeri, Umeki Yusuke, Mastumoto Noriaki, Mizuno Tomohiro, Usui Masanobu, Hirooka Yoshiki, Imaizumi Kazuyoshi, Suda Koichi
Department of Food and Nutrition Service, Fujita Health University Hospital, Toyoake, JPN.
Department of Surgery, Fujita Health University, Toyoake, JPN.
Cureus. 2025 Apr 2;17(4):e81622. doi: 10.7759/cureus.81622. eCollection 2025 Apr.
Objective In 2021, anamorelin, an orally active ghrelin receptor selective antagonist, was approved for the treatment of cachexia in patients with non-small cell lung cancer, gastric cancer, pancreatic cancer, and colon cancer. Cancer cachexia is classified into three stages: pre-cachexia, cachexia, and refractory cachexia, with the pre-cachexia and cachexia stages considered reversible with a combination of nutritional therapy, pharmacotherapy, and exercise therapy. In addition, treatment of cachexia requires early intervention, but diagnosis and early detection of cachexia are difficult. We hypothesized that the initiation of anamorelin treatment may be delayed in clinical practice and explored the appropriate timing of treatment initiation. Methods The data of patients with cachexia who received anamorelin at our hospital from June 2021 to July 2023 were retrospectively reviewed. Anamorelin was administered to 201 patients, of whom 134 were included in the study. Survival time and duration of medication were compared based on the number of objective criteria for anamorelin prescription (C-reactive protein [CRP] >0.5 mg/dL, hemoglobin <12 g/dL, albumin <3.2 g/dL). Multivariate analysis was used to determine the factors associated with continuation of anamorelin treatment for 12 weeks. Results Patients with a higher number of objective criteria for anamorelin prescription (CRP >0.5 mg/dL, hemoglobin <12 g/dL, albumin <3.2 g/dL) had shorter anamorelin treatment duration and survival. In multivariate analysis, 12 weeks of anamorelin treatment was associated with CRP. Comparing CRP ≤0.5 mg/dL vs. CRP >0.5 mg/dL, survival was significantly longer for CRP ≤0.5 mg/dL (p < 0.01). Conclusions Initiating anamorelin treatment with close attention to CRP and ensuring that prescribing criteria are met may be helpful in treating cachexia.
目的 2021年，口服活性生长激素释放肽受体选择性拮抗剂阿那莫林被批准用于治疗非小细胞肺癌、胃癌、胰腺癌和结肠癌患者的恶病质。癌症恶病质分为三个阶段：恶病质前期、恶病质期和难治性恶病质期，其中恶病质前期和恶病质期被认为可通过营养治疗、药物治疗和运动治疗相结合的方式逆转。此外，恶病质的治疗需要早期干预，但恶病质的诊断和早期检测较为困难。我们推测在临床实践中阿那莫林治疗的启动可能会延迟，并探讨了治疗开始的合适时机。方法 回顾性分析2021年6月至2023年7月在我院接受阿那莫林治疗的恶病质患者的数据。201例患者接受了阿那莫林治疗，其中134例纳入研究。根据阿那莫林处方的客观标准数量（C反应蛋白[CRP]>0.5mg/dL、血红蛋白<12g/dL、白蛋白<3.2g/dL）比较生存时间和用药持续时间。采用多因素分析确定与阿那莫林治疗持续12周相关的因素。结果 阿那莫林处方客观标准数量较多（CRP>0.5mg/dL、血红蛋白<12g/dL、白蛋白<3.2g/dL）的患者，阿那莫林治疗持续时间和生存期较短。在多因素分析中，阿那莫林治疗12周与CRP相关。比较CRP≤0.5mg/dL与CRP>0.5mg/dL，CRP≤0.5mg/dL的患者生存期明显更长（p<0.01）。结论 密切关注CRP启动阿那莫林治疗并确保符合处方标准可能有助于治疗恶病质。
