Ghrelin Injections Are Safe and May Help Cancer Patients With Severe Weight Loss | Research

The takeaway

Subcutaneous ghrelin injections were safe and well-tolerated in advanced cancer patients with cachexia, with positive effects on nutritional intake and patient-reported experiences despite the small study size.

Safe with no dose-limiting toxicity
In advanced cancer patients with cachexia, starting at 32 μg/kg subcutaneous

What the researchers found

Subcutaneous ghrelin was safe without dose-limiting toxicity in advanced cancer cachexia patients, with positive effects on nutritional intake and subjective experience despite variable appetite responses.

Why it matters

Cancer cachexia affects up to 80% of advanced cancer patients and contributes to mortality. Finding safe, effective treatments to maintain nutrition and muscle mass could improve both quality of life and survival outcomes.

The numbers in context

6 treated; 32 mcg/kg starting dose; 50% escalation; 88-day median survival; FAACT score decreased 6.8 points

How the study worked

Dose-finding Phase I/II trial with subcutaneous natural ghrelin in advanced cancer patients with cachexia. Starting dose 32 μg/kg with 50% escalations. Self-injection twice daily for 4-day periods. Measurements: safety, nutritional intake, appetite scores, muscle mass, and strength over 6 weeks.

Who was studied

Advanced cancer patients with metastatic solid tumors and cachexia (100% male, mean age 61.8)

What this study cannot tell us

Very small sample size (n=6 treated). All treated patients were male. Complex intervention design with multiple dose levels and washout periods. High attrition (only 3 completed the study). No control group.

How to read the evidence

Small, early-phase dose-finding study (n=6 treated). Provides safety data but limited efficacy evidence due to small sample and no control group.

When this study was published

Published in 2021, contributing to ongoing investigation of ghrelin for cancer cachexia management.

The bigger picture

Ghrelin, the body's hunger hormone, has long been studied as a potential treatment for cachexia. This small trial adds to the evidence that exogenous ghrelin is safe and tolerable, but highlights the complexity of treating a multifactorial syndrome like cancer cachexia where appetite alone isn't the only driver of weight loss.

Questions still open

What is the optimal ghrelin dose and schedule for sustained cachexia benefit?
Could ghrelin be combined with other interventions for greater effect on muscle mass?
Why do some patients respond to ghrelin while others show variable results?

Common questions

What is cancer cachexia and why is it so serious?

Cancer cachexia is a syndrome of severe involuntary weight loss, muscle wasting, and fatigue that affects up to 80% of advanced cancer patients. It significantly reduces quality of life and contributes to mortality, and currently has no fully effective treatment.

How does ghrelin help with cancer-related weight loss?

Ghrelin is the body's natural hunger hormone. Injecting additional ghrelin can stimulate appetite and food intake. In this trial, it improved nutritional intake and patients reported positive experiences, though appetite responses varied between individuals.

Read the original research

Natural ghrelin in advanced cancer patients with cachexia, a case series.

Journal of cachexia, sarcopenia and muscle, 12(2), 506-516

View on PubMed ↗Publisher’s paper ↗

Citation

Blum, David; de Wolf-Linder, Susanne; Oberholzer, Rolf; Brändle, Michael; Hundsberger, Thomas; Strasser, Florian. (2021). Natural ghrelin in advanced cancer patients with cachexia, a case series.. Journal of cachexia, sarcopenia and muscle, 12(2), 506-516. https://doi.org/10.1002/jcsm.12659