Pilot Clinical Trial of Repeated Doses of Macimorelin to Assess Safety and Efficacy in Patients With Cancer Cachexia

Inclusion Criteria:

1. Subjects ≥18 years of age with histological diagnosis of incurable cancer (solid
tumor),

2. ECOG performance status of 0-2,

3. Presence of cancer-related cachexia defined as an involuntary weight loss of at least
5% of the pre-illness body weight over the previous 6 months, and

4. Provide written informed consent prior to screening.

Exclusion Criteria:

1. Obesity (body weight >140 Kg);

2. Recent active excessive alcohol or illicit drug use;

3. Severe depression as determined by the investigator;

4. Other causes of cachexia such as: Liver disease (AST or ALT > 3x normal levels); renal
failure (creatinine >1.5 mg/dL), untreated thyroid disease, class III-IV CHF, AIDS,
severe COPD requiring use of home O2;

5. Inability to increase food intake (e.g., esophageal obstruction, intractable nausea
and vomiting);

6. Any condition that would prevent the subject from performing the research procedures
(e.g. unstable coronary artery disease);

7. Use of growth hormone, megestrol, Marinol, or any other anabolic agents, appetite
stimulants (including corticosteroids other than dexamethasone at the time of IV
chemotherapy administrations), tube feeding, or parenteral nutrition during the 1
month prior to entering the study;

8. Recent administration (less than 1 week) of highly emetogenic chemotherapy (Hesketh
scale class 4-5); subjects may otherwise be undergoing chemotherapy.

9. Being female and pregnant, breast-feeding or of childbearing potential. (Note: Lack of
childbearing potential for female patients is satisfied by: a) being post menopausal;
b) being surgically sterile; c) practicing contraception with an oral contraceptive,
intra-uterine device, diaphragm, or condom with spermicide for the duration of the
study; or d) being sexually inactive. Confirmation that the patient is not pregnant
will be established by a negative serum hCG pregnancy test at the time of enrollment.

10. Co-administration of drugs that prolong QT interval, CYP3A4 inducers, QTc equal to or
greater than 450ms at screening, or other investigational agents (a wash-out period of
five times the half life of drugs that prolong QT will be allowed with approval of
prescriber).

11. Conditions that would preclude from successfully scanning subjects in MRI:

- Claustrophobia (this would make lying in the scanner very uncomfortable); b.
having a pacemaker, aneurysm clips, neurostimulators, cochlear implants, metal in
eyes, steel worker, or other implants; c. History of Seizures d. History of head
injuries resulting in loss of consciousness > 10 minutes.