Anamorelin Administration Associated with Hyperglycemia in High Risk Patients, Requires Early Monitoring: Study

A new study published in the journal of Anticancer Research showed that nearly one-third of patients developed hyperglycemia with anamorelin, most often within the first month of treatment. Pre-existing diabetes and elevated ALT levels were identified as independent risk factors, which emphasized the importance of close glucose monitoring in high-risk individuals.

Anamorelin, which is a drug increasingly used to treat cancer cachexia, works as a ghrelin receptor agonist by promoting hunger and triggering growth hormone secretion. However, these same metabolic effects can interfere with glucose regulation, which raises concerns about insulin resistance. Clinical trials had suggested that severe hyperglycemia was relatively rare, but case reports have hinted at more serious risks. Until now, data from routine clinical practice have been limited.

This single-center retrospective study analyzed 129 patients with various cancers, including non-small-cell lung, gastric, pancreatic, and colorectal cancers, who received anamorelin between June 2021 and September 2023. Pancreatic cancer was the most common diagnosis, which accounted for 38% of cases.

The findings revealed that nearly one-third of patients (29.5%) developed hyperglycemia, where the blood glucose levels exceeded 200 mg/dl. Also, 20.2% experienced severe (Grade 3 or higher) events. These rates are significantly higher than those typically reported in controlled clinical trials, which illuminated that real-world patients may face greater risks.

Among patients who developed hyperglycemia, over 80% did so within the first 28 days of starting treatment. This early onset highlights a narrow window requiring vigilance from physicians.

With multivariate logistic regression analyses, this study identified two independent predictors which were the pre-existing diabetes mellitus and elevated alanine aminotransferase (ALT) levels above 42 IU/l. The patients with diabetes were over 7-times more likely to develop hyperglycemia, while those with high ALT levels had nearly a fivefold increased risk. These findings suggest that both metabolic and liver-related factors may contribute to vulnerability.

This study found no significant association between hyperglycemia and the use of corticosteroids or neurokinin-1 receptor antagonists which are often used along with cancer treatments. As anamorelin continues to be adopted in oncology care, clinicians should prioritize early and frequent glucose monitoring, particularly in patients with known diabetes or signs of liver dysfunction. Overall, proactive management strategies could help reduce complications and ensure that patients can continue benefiting from the drug’s positive effects on appetite and quality of life.

Source:

Yoshihiro Amakawa, Kazuo Kobayashi, Yuma Nonomiya, Hisanori Shimizu, Kazuyoshi Kawakami, Takashi Yokokawa, Naoki Sasahira, Masato Ozaka, Tsuyoshi Takeda, Kensei Yamaguchi, Daisuke Takahari, Makoto Nishio, Ryo Ariyasu, Toru Kitazawa, Masakazu Yamaguchi,. Timing and Risk Factors for Hyperglycemia Associated With Anamorelin Administration,. Anticancer Research May 2026, 46 (5) 2725-2733,. https://doi.org/10.21873/anticanres.18152