Anamorelin
Orally active ghrelin-receptor agonist developed for cancer cachexia. It increases appetite, lean body mass and body weight, and is approved in Japan for cachexia in several cancers, though it did not improve handgrip strength in trials.
01 Overview
Anamorelin (brand Adlumiz/Rayaldee-unrelated; JMT-101) is a selective agonist of the growth hormone secretagogue receptor that mimics ghrelin's orexigenic and anabolic signalling. In the ROMANA phase 3 programme it consistently raised lean body mass and appetite in patients with non-small-cell lung cancer cachexia.
It is approved in Japan for cancer cachexia in NSCLC, gastric, pancreatic and colorectal cancer, but was not approved in the US or EU because the co-primary endpoint of handgrip strength was not met. It is orally dosed and generally well tolerated.
02 Mechanism
Agonist at the ghrelin/GHSR-1a receptor, driving GH/IGF-1 secretion and central appetite stimulation, producing anabolic and orexigenic effects.
03 Dosing
| Tier | Dose | Route | Notes |
|---|---|---|---|
| Cachexia dose | 100 mg/day | Oral | Once daily on an empty stomach, as studied in ROMANA and Japanese trials. |
04 Effects
| Effect | Magnitude | Evidence | |
|---|---|---|---|
| Increased lean body massConsistently raised lean body mass in NSCLC cachexia trials. | +1.1 kg vs placebo over 12 wk | Clinical | |
| Improved appetiteGhrelin-mimetic appetite stimulation improved anorexia-cachexia symptom scores. | significant vs placebo | Clinical | |
| No handgrip strength gainDespite mass gains, functional strength did not improve significantly. | endpoint not met | Clinical |
05 Side effects
| Effect | Severity | Frequency | Evidence | Countermeasures |
|---|---|---|---|---|
| HyperglycaemiaElevated blood glucose and HbA1c, reflecting GH/IGF-1 axis activation. | Moderate | Common | Clinical | |
| NauseaMild GI upset early in treatment. | Mild | Common | Clinical |