Skip to main content
Top
Published in: Journal of Cachexia, Sarcopenia and Muscle 4/2014

01-12-2014 | Original Article

Anamorelin HCl (ONO-7643), a novel ghrelin receptor agonist, for the treatment of cancer anorexia-cachexia syndrome: preclinical profile

Authors: Claudio Pietra, Yasuhiro Takeda, Naoko Tazawa-Ogata, Masashi Minami, Xia Yuanfeng, Elizabeth Manning Duus, Robert Northrup

Published in: Journal of Cachexia, Sarcopenia and Muscle | Issue 4/2014

Login to get access

Abstract

Background

Anamorelin HCl (ANAM) is a novel, orally active, ghrelin receptor agonist in clinical development for the treatment of cancer cachexia. We report in vitro and in vivo studies evaluating the preclinical pharmacologic profile of ANAM.

Methods

Fluorescent imaging plate reader and binding assays in HEK293 and baby hamster kidney cells determined the agonist and antagonist activity of ANAM, and its affinity for the ghrelin receptor. Rat pituitary cells were incubated with ANAM to evaluate its effect on growth hormone (GH) release. In vivo, rats were treated with ANAM 3, 10, or 30 mg/kg, or control orally, once daily for 6 days to evaluate the effect on food intake (FI) and body weight (BW), and once to assess GH response. In pigs, single (3.5 mg/kg) or continuous (1 mg/kg/day) ANAM doses were administered to assess GH and insulin-like growth factor (IGF-1) response.

Results

ANAM showed significant agonist and binding activity on the ghrelin receptor, and stimulated GH release in vitro. In rats, ANAM significantly and dose-dependently increased FI and BW at all dose levels compared with control, and significantly increased GH levels at 10 or 30 mg/kg doses. Increases in GH and IGF-1 levels were observed following ANAM administration in pigs.

Conclusion

ANAM is a potent and highly specific ghrelin receptor agonist with significant appetite-enhancing activity, leading to increases in FI and BW, and a stimulatory effect on GH secretion. These results support the continued investigation of ANAM as a potential treatment of cancer anorexia-cachexia syndrome.
Literature
1.
go back to reference Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12:489–95.PubMedCrossRef Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12:489–95.PubMedCrossRef
3.
go back to reference Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med. 1980;69:491–7.PubMedCrossRef Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med. 1980;69:491–7.PubMedCrossRef
4.
go back to reference Kumar NB, Kazi A, Smith T, Crocker T, Yu D, Reich RR, et al. Cancer cachexia: traditional therapies and novel molecular mechanism-based approaches to treatment. Curr Treat Options Oncol. 2010;11:107–17.PubMedCentralPubMedCrossRef Kumar NB, Kazi A, Smith T, Crocker T, Yu D, Reich RR, et al. Cancer cachexia: traditional therapies and novel molecular mechanism-based approaches to treatment. Curr Treat Options Oncol. 2010;11:107–17.PubMedCentralPubMedCrossRef
5.
go back to reference Andreyev HJ, Norman AR, Oates J, Cunningham D. Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer. 1998;34:503–9.PubMedCrossRef Andreyev HJ, Norman AR, Oates J, Cunningham D. Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer. 1998;34:503–9.PubMedCrossRef
6.
go back to reference Ross PJ, Ashley S, Norton A, Priest K, Waters JS, Eisen T, et al. Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancers? Br J Cancer. 2004;90:1905–11.PubMedCentralPubMedCrossRef Ross PJ, Ashley S, Norton A, Priest K, Waters JS, Eisen T, et al. Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancers? Br J Cancer. 2004;90:1905–11.PubMedCentralPubMedCrossRef
7.
go back to reference Suzuki H, Asakawa A, Amitani H, Fujitsuka N, Nakamura N, Inui A. Cancer cachexia pathophysiology and translational aspect of herbal medicine. Jpn J Clin Oncol. 2013;43:695–705.PubMedCrossRef Suzuki H, Asakawa A, Amitani H, Fujitsuka N, Nakamura N, Inui A. Cancer cachexia pathophysiology and translational aspect of herbal medicine. Jpn J Clin Oncol. 2013;43:695–705.PubMedCrossRef
8.
go back to reference Dodson S, Baracos VE, Jatoi A, Evans JW, Cella D, Dalton JT, et al. Muscle wasting in cancer cachexia: clinical implications, diagnosis, and emerging treatment strategies. Annu Rev Med. 2011;62:265–79.PubMedCrossRef Dodson S, Baracos VE, Jatoi A, Evans JW, Cella D, Dalton JT, et al. Muscle wasting in cancer cachexia: clinical implications, diagnosis, and emerging treatment strategies. Annu Rev Med. 2011;62:265–79.PubMedCrossRef
10.
go back to reference Kojima M, Hosoda H, Date Y, Nakazato M, Matsuo H, Kangawa K. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature. 1999;402:656–60.PubMedCrossRef Kojima M, Hosoda H, Date Y, Nakazato M, Matsuo H, Kangawa K. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature. 1999;402:656–60.PubMedCrossRef
11.
go back to reference Argilés JM, Stemmler B. The potential of ghrelin in the treatment of cancer cachexia. Expert Opin Biol Ther. 2013;13:67–76.PubMedCrossRef Argilés JM, Stemmler B. The potential of ghrelin in the treatment of cancer cachexia. Expert Opin Biol Ther. 2013;13:67–76.PubMedCrossRef
12.
go back to reference Guillory B, Splenser A, Garcia J. The role of ghrelin in anorexia-cachexia syndromes. Vitam Horm. 2013;92:61–106.PubMedCrossRef Guillory B, Splenser A, Garcia J. The role of ghrelin in anorexia-cachexia syndromes. Vitam Horm. 2013;92:61–106.PubMedCrossRef
13.
go back to reference Wang W, Andersson M, Iresjö BM, Lönnroth C, Lundholm K. Effects of ghrelin on anorexia in tumor-bearing mice with eicosanoid-related cachexia. Int J Oncol. 2006;28:1393–400.PubMed Wang W, Andersson M, Iresjö BM, Lönnroth C, Lundholm K. Effects of ghrelin on anorexia in tumor-bearing mice with eicosanoid-related cachexia. Int J Oncol. 2006;28:1393–400.PubMed
14.
go back to reference DeBoer MD, Zhu XX, Levasseur P, Meguid MM, Suzuki S, Inui A, et al. Ghrelin treatment causes increased food intake and retention of lean body mass in a rat model of cancer cachexia. Endocrinology. 2007;148:3004–12.PubMedCrossRef DeBoer MD, Zhu XX, Levasseur P, Meguid MM, Suzuki S, Inui A, et al. Ghrelin treatment causes increased food intake and retention of lean body mass in a rat model of cancer cachexia. Endocrinology. 2007;148:3004–12.PubMedCrossRef
15.
go back to reference Neary NM, Small CJ, Wren AM, Lee JL, Druce MR, Palmieri C, et al. Ghrelin increases energy intake in cancer patients with impaired appetite: acute, randomized, placebo-controlled trial. J Clin Endocrinol Metab. 2004;89:2832–6.PubMedCrossRef Neary NM, Small CJ, Wren AM, Lee JL, Druce MR, Palmieri C, et al. Ghrelin increases energy intake in cancer patients with impaired appetite: acute, randomized, placebo-controlled trial. J Clin Endocrinol Metab. 2004;89:2832–6.PubMedCrossRef
16.
go back to reference Hiura Y, Takiguchi S, Yamamoto K, Takahashi T, Kurokawa Y, Yamasaki M, et al. Effects of ghrelin administration during chemotherapy with advanced esophageal cancer patients: a prospective, randomized, placebo-controlled phase 2 study. Cancer. 2012;118:4785–94.PubMedCrossRef Hiura Y, Takiguchi S, Yamamoto K, Takahashi T, Kurokawa Y, Yamasaki M, et al. Effects of ghrelin administration during chemotherapy with advanced esophageal cancer patients: a prospective, randomized, placebo-controlled phase 2 study. Cancer. 2012;118:4785–94.PubMedCrossRef
17.
go back to reference Lundholm K, Gunnebo L, Körner U, Iresjö BM, Engström C, Hyltander A, et al. Effects by daily long term provision of ghrelin to unselected weight-losing cancer patients: a randomized double-blind study. Cancer. 2010;116:2044–52.PubMedCrossRef Lundholm K, Gunnebo L, Körner U, Iresjö BM, Engström C, Hyltander A, et al. Effects by daily long term provision of ghrelin to unselected weight-losing cancer patients: a randomized double-blind study. Cancer. 2010;116:2044–52.PubMedCrossRef
18.
go back to reference Morozumi N, Hanada T, Habara H, Yamaki A, Furuya M, Nakatsuka T, et al. The role of C-terminal part of ghrelin in pharmacokinetic profile and biological activity in rats. Peptides. 2011;32:1001–7.PubMedCrossRef Morozumi N, Hanada T, Habara H, Yamaki A, Furuya M, Nakatsuka T, et al. The role of C-terminal part of ghrelin in pharmacokinetic profile and biological activity in rats. Peptides. 2011;32:1001–7.PubMedCrossRef
19.
go back to reference Kumor K, Polvino W. Biologic activity of RC-1291, a novel oral ghrelin mimetic for cancer anorexia/cachexia: results from a Phase I randomized, double-blind, placebo-controlled trial in healthy volunteers. Support Care Cancer. 2006;14:593. Abstract 03–009. Kumor K, Polvino W. Biologic activity of RC-1291, a novel oral ghrelin mimetic for cancer anorexia/cachexia: results from a Phase I randomized, double-blind, placebo-controlled trial in healthy volunteers. Support Care Cancer. 2006;14:593. Abstract 03–009.
20.
go back to reference Blum R, Polvino W. Pharmacokinetic (PK) profile of RC-1291, a novel oral ghrelin mimetic for the treatment of cancer anorexia/cachexia. Support Care Cancer. 2006;14:593. Abstract 03–010. Blum R, Polvino W. Pharmacokinetic (PK) profile of RC-1291, a novel oral ghrelin mimetic for the treatment of cancer anorexia/cachexia. Support Care Cancer. 2006;14:593. Abstract 03–010.
21.
go back to reference Garcia JM, Polvino WJ. Effect on body weight and safety of RC-1291, a novel, orally available ghrelin mimetic and growth hormone secretagogue: results of a phase I, randomized, placebo-controlled, multiple-dose study in healthy volunteers. Oncologist. 2007;12:594–600.PubMedCrossRef Garcia JM, Polvino WJ. Effect on body weight and safety of RC-1291, a novel, orally available ghrelin mimetic and growth hormone secretagogue: results of a phase I, randomized, placebo-controlled, multiple-dose study in healthy volunteers. Oncologist. 2007;12:594–600.PubMedCrossRef
22.
go back to reference Garcia JM, Friend J, Allen S. Therapeutic potential of anamorelin, a novel, oral ghrelin mimetic, in patients with cancer-related cachexia: a multicenter, randomized, double-blind, crossover, pilot study. Support Care Cancer. 2013;21:129–37.PubMedCrossRef Garcia JM, Friend J, Allen S. Therapeutic potential of anamorelin, a novel, oral ghrelin mimetic, in patients with cancer-related cachexia: a multicenter, randomized, double-blind, crossover, pilot study. Support Care Cancer. 2013;21:129–37.PubMedCrossRef
23.
go back to reference Abernethy AP, Temel JS, Currow D, Gleich LL, Friend J. Phase III clinical trials with anamorelin HCl, a novel oral treatment for NSCLC cachexia. J Clin Oncol. 2013;31(suppl): Abstract TPS9649. Abernethy AP, Temel JS, Currow D, Gleich LL, Friend J. Phase III clinical trials with anamorelin HCl, a novel oral treatment for NSCLC cachexia. J Clin Oncol. 2013;31(suppl): Abstract TPS9649.
24.
go back to reference Northrup R, Kuroda K, Duus EM, Barnes SR, Cheatham L, Wiley T, et al. Effect of ghrelin and anamorelin (ONO-7643), a selective ghrelin receptor agonist, on tumor growth in a lung cancer mouse xenograft model. Support Care Cancer. 2013;21:2409–15.PubMedCentralPubMedCrossRef Northrup R, Kuroda K, Duus EM, Barnes SR, Cheatham L, Wiley T, et al. Effect of ghrelin and anamorelin (ONO-7643), a selective ghrelin receptor agonist, on tumor growth in a lung cancer mouse xenograft model. Support Care Cancer. 2013;21:2409–15.PubMedCentralPubMedCrossRef
25.
go back to reference Garcia JM, Polvino WJ. Pharmacodynamic hormonal effects of anamorelin, a novel oral ghrelin mimetic and growth hormone secretagogue in healthy volunteers. Growth Horm IGF Res. 2009;19:267–73.PubMedCrossRef Garcia JM, Polvino WJ. Pharmacodynamic hormonal effects of anamorelin, a novel oral ghrelin mimetic and growth hormone secretagogue in healthy volunteers. Growth Horm IGF Res. 2009;19:267–73.PubMedCrossRef
26.
go back to reference Temel J, Bondarde S, Jain M, Allen S, Mann W. Efficacy and safety of anamorelin HCl in NSCLC patients: results from a randomized, double-blind, placebo-controlled, multicentre phase II study. Eur J Cancer. 2013;49 (Suppl 2): Abstract 1308. Temel J, Bondarde S, Jain M, Allen S, Mann W. Efficacy and safety of anamorelin HCl in NSCLC patients: results from a randomized, double-blind, placebo-controlled, multicentre phase II study. Eur J Cancer. 2013;49 (Suppl 2): Abstract 1308.
27.
go back to reference White HK, Petrie CD, Landschulz W, MacLean D, Taylor A, Lyles K, et al. Effects of an oral growth hormone secretagogue in older adults. J Clin Endocrinol Metab. 2009;94:1198–206.PubMedCrossRef White HK, Petrie CD, Landschulz W, MacLean D, Taylor A, Lyles K, et al. Effects of an oral growth hormone secretagogue in older adults. J Clin Endocrinol Metab. 2009;94:1198–206.PubMedCrossRef
28.
go back to reference Nass R, Pezzoli SS, Oliveri MC, Patrie JC, Harrell Jr FE, Clasey JL, et al. Effects of an oral ghrelin mimetic on body composition and clinical outcomes in healthy older adults: a randomized trial. Ann Intern Med. 2008;149:601–11.PubMedCentralPubMedCrossRef Nass R, Pezzoli SS, Oliveri MC, Patrie JC, Harrell Jr FE, Clasey JL, et al. Effects of an oral ghrelin mimetic on body composition and clinical outcomes in healthy older adults: a randomized trial. Ann Intern Med. 2008;149:601–11.PubMedCentralPubMedCrossRef
29.
go back to reference Kato Y, Murakami Y, Sohmiya M, Nishiki M. Regulation of human growth hormone secretion and its disorders. Intern Med. 2002;41:7–13.PubMedCrossRef Kato Y, Murakami Y, Sohmiya M, Nishiki M. Regulation of human growth hormone secretion and its disorders. Intern Med. 2002;41:7–13.PubMedCrossRef
30.
go back to reference Reichlin S. Neuroendocrinology. In: Wilson JD, Foster DW, Kronenberg HM, Larsen PR, editors. William's textbook of endocrinology. Philadelphia: Saunders; 1998. p. 165–248. Reichlin S. Neuroendocrinology. In: Wilson JD, Foster DW, Kronenberg HM, Larsen PR, editors. William's textbook of endocrinology. Philadelphia: Saunders; 1998. p. 165–248.
31.
go back to reference Piccoli F, Degen L, MacLean C, Peter S, Baselgia L, Larsen F, et al. Pharmacokinetics and pharmacodynamic effects of an oral ghrelin agonist in healthy subjects. J Clin Endocrinol Metab. 2007;92:1814–20.PubMedCrossRef Piccoli F, Degen L, MacLean C, Peter S, Baselgia L, Larsen F, et al. Pharmacokinetics and pharmacodynamic effects of an oral ghrelin agonist in healthy subjects. J Clin Endocrinol Metab. 2007;92:1814–20.PubMedCrossRef
32.
go back to reference Ali SA, Garcia JM. Randomized clinical trial of the novel oral ghrelin mimetic macimorelin in the treatment of cancer cachexia: study design and preliminary results. Endocr Rev. 2013;34: Abstract MON-327. Ali SA, Garcia JM. Randomized clinical trial of the novel oral ghrelin mimetic macimorelin in the treatment of cancer cachexia: study design and preliminary results. Endocr Rev. 2013;34: Abstract MON-327.
33.
go back to reference Møller N, Jørgensen JO. Effects of growth hormone on glucose, lipid, and protein metabolism in human subjects. Endocr Rev. 2009;30:152–77.PubMedCrossRef Møller N, Jørgensen JO. Effects of growth hormone on glucose, lipid, and protein metabolism in human subjects. Endocr Rev. 2009;30:152–77.PubMedCrossRef
35.
go back to reference Gong Y, Yao E, Shen R, Goel A, Arcila M, Teruya-Feldstein J, et al. High expression levels of total IGF-1R and sensitivity of NSCLC cells in vitro to an anti-IGF-1R antibody (R1507). PLoS One. 2009;4:e7273.PubMedCentralPubMedCrossRef Gong Y, Yao E, Shen R, Goel A, Arcila M, Teruya-Feldstein J, et al. High expression levels of total IGF-1R and sensitivity of NSCLC cells in vitro to an anti-IGF-1R antibody (R1507). PLoS One. 2009;4:e7273.PubMedCentralPubMedCrossRef
36.
go back to reference Koo GC, Huang C, Camacho R, Trainor C, Blake JT, Sirotina-Meisher A, et al. Immune enhancing effect of a growth hormone secretagogue. J Immunol. 2001;166:4195–201.PubMedCrossRef Koo GC, Huang C, Camacho R, Trainor C, Blake JT, Sirotina-Meisher A, et al. Immune enhancing effect of a growth hormone secretagogue. J Immunol. 2001;166:4195–201.PubMedCrossRef
37.
go back to reference Khan AS, Anscombe IW, Cummings KK, Pope MA, Smith LC, Draghia-Akli R. Effects of plasmid-mediated growth hormone-releasing hormone supplementation on LL-2 adenocarcinoma in mice. Mol Ther. 2003;8:459–66.PubMedCrossRef Khan AS, Anscombe IW, Cummings KK, Pope MA, Smith LC, Draghia-Akli R. Effects of plasmid-mediated growth hormone-releasing hormone supplementation on LL-2 adenocarcinoma in mice. Mol Ther. 2003;8:459–66.PubMedCrossRef
38.
go back to reference Khan AS, Smith LC, Anscombe IW, Cummings KK, Pope MA, Draghia-Akli R. Growth hormone releasing hormone plasmid supplementation, a potential treatment for cancer cachexia, does not increase tumor growth in nude mice. Cancer Gene Ther. 2005;12:54–60.PubMedCrossRef Khan AS, Smith LC, Anscombe IW, Cummings KK, Pope MA, Draghia-Akli R. Growth hormone releasing hormone plasmid supplementation, a potential treatment for cancer cachexia, does not increase tumor growth in nude mice. Cancer Gene Ther. 2005;12:54–60.PubMedCrossRef
39.
go back to reference Perboni S, Bowers C, Kojima S, Asakawa A, Inui A. Growth hormone releasing peptide 2 reverses anorexia associated with chemotherapy with 5-fluorouracil in colon cancer cell-bearing mice. World J Gastroenterol. 2008;14:6303–5.PubMedCentralPubMedCrossRef Perboni S, Bowers C, Kojima S, Asakawa A, Inui A. Growth hormone releasing peptide 2 reverses anorexia associated with chemotherapy with 5-fluorouracil in colon cancer cell-bearing mice. World J Gastroenterol. 2008;14:6303–5.PubMedCentralPubMedCrossRef
40.
go back to reference Farris GM, Miller GK, Wollenberg GK, Molon-Noblot S, Chan C, Prahalada S. Recombinant rat and mouse growth hormones: risk assessment of carcinogenic potential in 2-year bioassays in rats and mice. Toxicol Sci. 2007;97:548–61.PubMedCrossRef Farris GM, Miller GK, Wollenberg GK, Molon-Noblot S, Chan C, Prahalada S. Recombinant rat and mouse growth hormones: risk assessment of carcinogenic potential in 2-year bioassays in rats and mice. Toxicol Sci. 2007;97:548–61.PubMedCrossRef
Metadata
Title
Anamorelin HCl (ONO-7643), a novel ghrelin receptor agonist, for the treatment of cancer anorexia-cachexia syndrome: preclinical profile
Authors
Claudio Pietra
Yasuhiro Takeda
Naoko Tazawa-Ogata
Masashi Minami
Xia Yuanfeng
Elizabeth Manning Duus
Robert Northrup
Publication date
01-12-2014
Publisher
Springer Berlin Heidelberg
Published in
Journal of Cachexia, Sarcopenia and Muscle / Issue 4/2014
Print ISSN: 2190-5991
Electronic ISSN: 2190-6009
DOI
https://doi.org/10.1007/s13539-014-0159-5

Other articles of this Issue 4/2014

Journal of Cachexia, Sarcopenia and Muscle 4/2014 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.