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TOPLINE:

Mirtazapine has been suggested as an option for cancer-related anorexia in patients with advanced non–small cell lung cancer (NSCLC).

METHODOLOGY:

• Currently, there is no standard treatment of cancer-associated anorexia, with more than half of patients with lung cancer being affected.
• Investigators randomized 86 patients with anorexia with advanced NSCLC equally to either mirtazapine or placebo for 8 weeks. Patients were being treated in the first line primarily with tyrosine kinase inhibitors and chemotherapy.
• Mirtazapine was dosed at 15 mg daily for the first 2 weeks and then 30 mg daily through week 8, a higher dosage than used in past trials.
• Appetite was assessed on the Anorexia Cachexia Scale, and energy intake was tracked by 24-hour dietary recall.
• The median Anorexia Cachexia Scale score was 20.4 points in the placebo group and 18.6 points in the mirtazapine arm at baseline.

TAKEAWAY:

• There was a significant increase in appetite score in both arms at 4 and 8 weeks; however, investigators noted no significant differences between the cohorts.
• After 4 weeks, the mirtazapine group had added almost 400 calories to their diet, including 22.4 g of protein, 43.4 g of carbohydrates, and 13.2 g of fat; a smaller improvement in the placebo arm was not statistically significant. Fat intake was significantly higher in the mirtazapine group at 8 weeks, 14.5 g vs 0.7 g in the placebo group.
• The proportion of mirtazapine patients with sarcopenia diminished at 8 weeks from 59.5% of patients to 57.1%, while sarcopenia increased in the placebo arm from 75% of subjects at baseline to 82.8%.
• Mirtazapine had positive effects in global health status at 8 weeks, including improvements in anxiety and depression scores and cognitive functioning. Drowsiness, dizziness, anxiety, tremors, and insomnia were similar in both arms, and there were no cases of somnolence.

IN PRACTICE:

Based on these findings, "mirtazapine is a feasible and safe option to add as a nutritional intervention in patients with advanced NSCLC with anorexia given its benefit in energy intake including high-quality macronutrients," researchers wrote.

SOURCE:

The work was led by Oscar Arrieta, MD, of the National Cancer Institute of Mexico, Mexico City, and published on January 11, 2024, in JAMA Oncology.

LIMITATIONS:

This was a single-center study with a small sample size that relied on patient-reported outcomes. Outcomes may have been influenced by the oncology drugs patients were on.

DISCLOSURES:

The work was funded by the Mexican Academy of Sciences and L'Oréal-UNESCO, Conalmex. One investigator reported speaker fees from AstraZeneca.