Significance of neutrophil-to-lymphocyte ratio in predicting the efficacy of anamorelin treatment for cancer cachexia

Abstract Purpose: Cancer cachexia is a multifactorial syndrome characterized by persistent loss of skeletal muscle mass, adversely affecting chemotherapy tolerability and life expectancy. Despite the expected therapeutic effect of anamorelin’s appetite-promotion,its efficacy has not been investigated in clinical practice. Given the involvement of cancer-inducing cytokines in cancer cachexia, we investigated whether the inflammatory biomarker neutrophil-to-lymphocyte ratio (NLR) could predict treatment outcomes. Methods: This study included patients receiving anamorelin for cancer cachexia associated with pancreatic, nonsmall-cell lung, gastric, and colorectal cancers between April 2021 and December 2023. Patients were classified based on their NLR (<5 or ≥5) at 4 weeks postanamorelin administration. The NLR changes before and 4 weeks after of anamorelin therapy and 1-year overall survival (OS) rates were compared between the two groups. Results: Out of 66 patients who received anamorelin, those with NLR <5 (n = 50) at 4 weeks postanamorelin administration showed a significant decrease in mean NLR from 3.71 ± 3.12 to 2.44 ± 1.23. Conversely, patients with an NLR ≥5 at 4 weeks (n = 16) had a significant increase from 5.70 ± 2.78 to 9.52 ± 4.85. The 1-year OS was significantly increased in patients with NLR of <5. Receiver–operating characteristic (ROC) analysis suggested that an NLR <4.4 before treatment potentially change to NLR <5 after anamorelin treatment, indicating NLR’s potential as a prognostic marker. Conclusion: NLR was suggested to be an effective indicator for predicting the therapeutic effect of anamorelin.