Predictors of 12-Week Anamorelin Treatment Continuation in Gastrointestinal Cancer Cachexia: A Single-Center,...

Although anamorelin improves appetite and body composition in cancer cachexia, early discontinuation is common. We aimed to evaluate predictors of 12-week treatment completion and longitudinal changes among patients who completed treatment. This single-center, retrospective study included patients with advanced gastrointestinal cancer who received anamorelin for cachexia (July 2021-March 2025). Baseline factors were compared between continuation and discontinuation groups, and predictors were assessed using multivariable logistic regression. Of 89 eligible patients, 36 (40.4%) completed 12 wk of treatment. In multivariable analyses, Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥1 (OR, 0.39; 95% CI, 0.15-0.98; p = 0.048) and neutrophil-to-lymphocyte ratio (NLR) ≥3.0 (OR, 0.35; 95% CI, 0.12-0.95; p = 0.047) were associated with lower treatment completion. In another model, NLR ≥3.0 remained significantly associated with lower treatment completion, while concurrent systemic anticancer therapy at anamorelin initiation showed a nonsignificant association with treatment completion (OR, 4.42; 95% CI, 0.92-43.07; p = 0.064). In the continuation group, nutritional status, body composition, handgrip strength, and anorexia-related symptoms improved, whereas NLR increased. Impaired ECOG PS and elevated NLR were associated with failure to complete 12-week anamorelin treatment. Earlier initiation of anamorelin before performance status declines and systemic inflammation progresses may support treatment completion.