The cancer cachexia market is estimated to be valued at USD 2.66 Bn in 2024 and is expected to reach USD 4.11 Bn by 2031, growing at a compound annual growth rate (CAGR) of 6.4% from 2024 to 2031. Rising awareness among patients and healthcare professionals regarding management of cancer related weight loss is expected to boost the demand. Moreover, development and commercialization of novel drugs and therapies for cachexia indication will further support the market growth through 2031.

Market Driver - Increasing Prevalence of Cancer Cachexia in Advanced Cancer Patients

The number of patients suffering from advanced and metastatic forms of cancer has been steadily increasing over the years. One of the major co-morbidities associated with advanced cancer is cachexia. Cachexia leads to muscle wasting through various mechanisms induced by cancer itself or chemotherapy and radiotherapy undergoing treatment.

Concurrently, cancer often causes malabsorption and disruption of normal metabolic pathways reducing appetite and food intake in patients. With modern advances in cancer screening and diagnostics coupled with effective targeted and immunotherapies, many patients are able to survive longer periods even after advanced stage diagnosis. However, prolonged survival also means patients have to cope with cancer for extended durations which increases their likelihood of developing cachexia.

Moreover, supportive and palliative care approaches also now allow many non-curable patients to live with manageable symptoms leading to rising prevalence of cachexia in advanced cancer populations. Therefore, with increasing cancer incidence and improved survival rates especially in developed nations, cachexia attributable morbidities are projected to grow significantly. This poses a serious treatment challenge necessitating novel therapeutic avenues for cancer cachexia.

Market Driver - Rising Investment in R&D for Novel Therapies like Ghrelin Receptor Agonists

Major pharmaceutical companies and small biotechs have started dedicating larger funds and resources in past decade to develop effective therapies targeting cancer cachexia. Currently, there are no approved drugs specific for cachexia indication and management involves off-label usage of common appetite stimulants or steroids.

However, these drugs provide limited benefits and are often associated with severe side effects especially upon long term usage. This unmet clinical need has spurred extensive research into molecular mechanisms underlying cachexia pathology. One such promising target attracting substantial industry interest is ghrelin signaling pathway.

Ghrelin is an orexigenic hormone normally produced in stomach which plays a key role in regulating appetite and metabolic functions. Studies showed ghrelin levels significantly reduced in cachectic cancer patients. Preclinical research validated ghrelin receptor agonist’s ability to reverse muscle wasting, increase food intake and body weight in various rodent cachexia models. This provided strong rationale for developing ghrelin analogues as anti-cachectic drugs, contributing to the growth of the cancer cachexia market.

Market Challenge - Lack of FDA-approved Therapies Limits Treatment Options

The cancer cachexia market faces significant challenges due to the lack of FDA-approved drug therapies specifically indicated for the treatment of cancer-related weight loss and muscle wasting. Currently, there are no drugs approved by the FDA for the treatment of cachexia associated with cancer or other chronic wasting diseases.

The only options available are mainly appetite stimulants or corticosteroids prescribed off-label, which have limited efficacy and come with significant safety risks when used long-term. This leaves oncologists and patients without adequate therapeutic alternatives for effectively managing cachexia. The lack of approved therapies also hinders efforts among pharmaceutical companies to invest further in research and development towards more effective and safer cachexia treatments.

More clinical research initiatives and collaborations between drug developers are needed to better understand the pathophysiology of cachexia and identify promising drug candidates that can obtain regulatory approval and transform patient care.

Market Opportunity - Increasing Focus on Developing Personalized Treatments Targeting Cachexia

The growing awareness and understanding of cancer cachexia presents attractive opportunities for companies operating in this market. There is an increasing focus in the oncology space on developing more personalized treatments that address the specific biological mechanisms underlying individual patients' cancer cachexia.

Several biotech companies and large pharmaceutical firms are engaged in clinical trials evaluating novel compounds targeting multiple cachexia pathways, such as inflammation, metabolic dysregulation and anorexia. They are also exploring opportunities for combinations with existing oncology medicines. This pipeline of potential new therapies has generated optimism that more safe and effective options for cachexia management can be made available in the near future.

As research in biomarkers and personalized screening of cachexia progresses, pharmaceutical firms may also be able to identify patient subgroups most likely to respond to certain targeted treatments. Such precision approaches could help optimize development of therapies and achieve better clinical outcomes in cancer cachexia.

For early-stage cancers, prescribers typically first recommend lifestyle interventions like nutritional counseling and exercise. If these conservative measures are insufficient, medications may be prescribed.

In late-stage cancers, cachexia is more severe and multifaceted interventions are needed. First-line pharmacotherapy involves appetite stimulants alongside nutritional support. Common appetite stimulant choices include Megestrol (Megace), a progestin shown to increase appetite and weight gain. Other options include corticosteroids such as Dexamethasone (Dexacort), which can alleviate inflammation and symptoms.

For patients who do not respond adequately to first-line options, second-line treatments provide alternative mechanisms of action. These include selective androgen receptor modulators like Enobosarm (Ostarine), which build muscle mass, and ghrelin receptor agonists exemplified by Relamorelin (Relamorelin), which stimulate appetite signaling pathways. If weight loss and muscle wasting continue to progress despite multiple lines of treatment, palliative care focusing on comfort measures is prioritized.

Prescribers also consider medication side effect profiles, especially for late-stage patients with lower performance status. While Megace and Dexacort are widely used first-line due to efficacy data, side effects like fluid retention and hyperglycemia influence prescribing in fragile patients. Newer second-line options present improved tolerability, making them preferable choices when first-line options fail or induce intolerable effects.

Cancer cachexia is a wasting syndrome commonly seen in late-stage cancer patients. It is characterized by loss of muscle mass and adipose tissue. Treatment options vary depending on the stage of disease.

For early-stage cachexia with minimal weight loss (<5%), lifestyle modifications like nutrition supplementation and low-impact exercise are recommended. Medications are usually not needed at this stage.

As cachexia progresses and weight loss increases to 5-10%, treatment moves to the first-line medication category. Appetite stimulants like megestrol acetate (Megace) are often prescribed to boost appetite and caloric intake. Anti-inflammatory corticosteroids such as dexamethasone may be used to reduce cachectic factors and increase weight.

For patients experiencing more than 10% weight loss or those with reduced food intake and metabolism, second-line therapies are used. These include combination regimens targeting multiple cachectic mechanisms. Common combinations used are enobosarm (Osterine) - an androgen receptor modulator along with somatropin (Humatrope), an appetite-inducing growth hormone. Anamorelin (ONO-7643) - a ghrelin receptor agonist along with anti-inflammatory omega-3 fatty acids is another popular option.

Third-line or palliative care focuses on symptomatic relief and improving quality of life for end-stage patients through pain management and nutritional counselling.

Strategy #1: Focus on combination drug therapies

One of the most successful strategies adopted has been developing combination drug therapies that target multiple biological pathways involved in cachexia. For example, in 2013, Helsinn launched Megace ES (megestrol acetate and esomeprazole), a combination drug to treat anorexia, weight loss, and gastroesophageal reflux associated with cancer or AIDS. Clinical trials showed it helped patients gain weight significantly more than megestrol acetate alone.

Strategy #2: Acquisitions and partnerships to expand pipeline

Given the high costs involved, companies adopt M&A strategies to gain new drugs and pipeline assets. In 2015, Lynton acquired MyoKardia for $225M to obtain its lead drug candidate mavacamten for cardiac muscle disorders often seen in cachexia. Around the same time, Helsinn partnered with Taiho Pharma to develop ganetyrosine (tyrosine kinase inhibitor) in Japan. Such deals help expand portfolio and commercialization reach.

Strategy #3: Targeting emerging markets

With rising cancer rates in developing nations, players focus on regulatory approvals and access in emerging markets which offer higher growth potential. For example, in 2017, VivoPharma received China NDA approval for Repinotan HCl to treat cancer cachexia, gaining first-mover advantage in the largest pharma market.

Insights, By Drug: Strong Efficacy Drives Adoption of Anabolic Steroids

In terms of drug, anabolic steroids are expected to account for 53.4% share of the market in 2024, owning to its strong efficacy in stimulating appetite and helping regain weight and muscle mass lost due to cancer cachexia. Key anabolic steroids used for cancer cachexia include nandrolone decanoate and oxandrolone.

Nandrolone decanoate is highly preferred owing to its ability to reverse weight loss and normalize testosterone levels in men with cancer. It works by promoting the growth of skeletal muscle mass and stimulating muscle protein synthesis. Oxandrolone is also commonly used due to its effectiveness in increasing body weight and lean body mass. It reduces fatigue and weaknesses in patients.

The pronounced effect of anabolic steroids on stimulating appetite and enhancing protein synthesis makes them highly suitable for treating cancer cachexia during its early stages when nutritional intervention is critical.

Insights, By Route of Administration: Ease of Administration Boosts Oral Drug Adoption

In terms of route of administration, oral administration is expected to account for 60.1% share of the market in 2024, owing to the ease of administration associated with oral drugs. Patients generally prefer oral medications over injectables and intravenous drugs as oral drugs avoid infusion-related complications and hospital visits for administration.

Key orally-administered drugs for cancer cachexia include oral nutritional supplements, megestrol acetate, and corticosteroids. Megestrol acetate suspension and tablets are widely used as they help increase appetite and weight gain. Oral corticosteroids such as dexamethasone are also adopted due their anti-inflammatory qualities and availability in oral form. The non-invasive nature of oral drugs makes them suited for long-term outpatient use to manage cancer cachexia.

Insights, By Disease Stage: Early Intervention Yields Better Outcomes in Early-stage Cachexia

In terms of disease stage, early-stage cachexia contributes the highest share of the market as management is found to be more effective and yields better outcomes when initiated during the early stages of the condition. Nutritional interventions and appetite stimulants work optimally if given when the patient has started losing weight but significant muscle and weight loss is yet to occur.

Early detection and diagnosis of cachexia helps intervene with corrective treatments before advanced muscle wasting and fatigue sets in. Managing early-stage cachexia prevents further worsening of symptoms and subsequent transition to late-stage disease. It also helps patients retain better quality of life for longer. This underscores the need for timely nutrition assessment and ongoing monitoring of cancer patients.

• Cachexia is responsible for up to 22% of cancer patient deaths, highlighting the urgent need for targeted therapies.
• Cachexia affects 87% of pancreatic cancer patients and 40% of breast cancer patients, underscoring the wide variance in its prevalence among cancer types.
• Approximately 80% of patients with advanced cancer experience cachexia, significantly impacting their quality of life. With the introduction of therapies like Anamorelin and ART27.13, the market is expected to shift towards more comprehensive treatment approaches.
• Cancer cachexia therapies are gaining traction, especially with Helsinn's Anamorelin and Pfizer’s PF-06946860 showing positive results in Phase II/III trials. These treatments have shown potential to reverse the muscle wasting and weight loss seen in late-stage cancer patients.

The major players operating in the cancer cachexia market include Helsinn Therapeutics, Actimed Therapeutics, Pfizer, Aveo Oncology, Artelo Biosciences, and Aphios Corporation.

• In May 2024, Actimed Therapeutics announced that it has scheduled the progressing of ACM-001.1 into Phase III clinical trials to take place in 2025. Actimed's lead product, S-pindolol benzoate (ACM-001.1), which targets cancer cachexia, is preparing for Phase 2b/3 trials as part of the IMPACT clinical program. This program aims to address the unmet needs in managing cancer cachexia by improving muscle mass and reducing catabolism.
• In March 2024, Pfizer’s ponsegromab, a monoclonal antibody targeting GDF-15, showed promising Phase II results in patients with cancer cachexia. The trial demonstrated a significant reduction in weight loss, with ponsegromab increasing body weight by up to 5.61% in the highest dose group. This drug targets GDF-15, a key cytokine involved in the development of cachexia, a condition that leads to severe weight and muscle loss in cancer patients. The trial results were presented at the European Society for Medical Oncology (ESMO) 2024 Congress, and Pfizer indicated plans to move forward with late-stage trials​.
• In January 2024, AVEO Pharmaceuticals reported initial Phase I results for AV-380, a monoclonal antibody targeting inflammation in cachexia patients, aiming to improve survival and quality of life. AVEO has indeed been developing AV-380, a monoclonal antibody targeting Growth Differentiation Factor 15 (GDF15), for treating cancer cachexia. This drug is in early-stage trials, with Phase I trials being conducted to evaluate its safety and pharmacokinetics. The aim of AV-380 is to address cachexia, a metabolic syndrome causing severe weight loss and inflammation in cancer patients, thereby potentially improving their survival and quality of life.
• In January 2021, Helsinn Therapeutics and its partner, Ono Pharmaceutical, launched Adlumiz® (anamorelin hydrochloride) in Japan. This ghrelin receptor agonist is designed to treat cancer cachexia in patients with non-small cell lung cancer (NSCLC), as well as other cancers like gastric, pancreatic, and colorectal cancers. The drug has been shown to improve body weight, muscle mass, and appetite, which are key issues in cancer cachexia. The approval was based on clinical studies demonstrating its effectiveness in managing these symptoms in patients.

• By Drug
  • Anabolic Steroids
  • Anti-inflammatory Drugs
• By Route of Administration
  • Oral
  • Parenteral
• By Disease Stage
  • Early-stage Cachexia
  • Late-stage Cachexia