Is Clarithromycin a Potential Treatment for Cachexia in People With Lung Cancer?

Inclusion Criteria:

* Adults with stage IV, pathologically confirmed, NSCLC not suitable for/declining/not tolerating 1st/2nd-line palliative chemotherapy, or following completion of 1st/2nd-line palliative chemotherapy
* A likely prognosis of ≥3 months.
* Cachexia on the basis of any of the following, weight loss \>5% over past 6 months, or BMI \<20kg/m2 and weight loss \>2%, or appendicular skeletal muscle index determined by duel energy x-ray absorptiometry consistent with sarcopenia and weight loss \>2%.
* Systemic inflammation on the basis of a C-reactive protein \>10mg/L.
* Adequate renal function as defined by creatinine ≤132micromol/L and eGFR ≥30mL/min/1.73m2
* Adequate liver function as defined by the following parameters, bilirubin ≤25micromol/L, and AST and ALT ≤2 times upper limit of normal, unless liver metastases, in which case ≤5 times upper limit of normal
* Prepared to suspend, if necessary, the use of certain statins and/or substitute the use of domperidone for an alternative anti-emetic for the duration of the study

Exclusion Criteria:

* ECOG Performance Status 3 or 4
* Little or no food intake
* Weight loss \>10% in 1 month or \>20% in total
* Known hypersensitivity to clarithromycin
* Inability to accurately measure QT interval, e.g. atrial fibrillation
* QTc prolongation \>450 milliseconds in a male, or 470 milliseconds in a female
* History of ventricular arrhythmia
* Severe cardiac insufficiency (NYHA class \>2)
* Untreated hypokalaemia/hypomagnesaemia
* Active infection requiring antibiotics
* Current or recent (within last 4 weeks) history of Clostridium difficile, eating disorder, dysphagia, malabsorption or diarrhoea
* Untreated adrenal or thyroid diseases
* Brain metastases
* Use of corticosteroids/progestogens
* Use of chemotherapy, other immunosuppressive, or antiviral (e.g. hepatitis C, HIV) drugs within 4 weeks
* Drugs which are contra-indicated (except certain statins which can be temporarily suspended and domperidone which can be substituted for an alternative anti-emetic) or should be avoided in patients receiving clarithromycin, either because of the risk of a drug-drug interaction and/or prolonged QT
* Pregnancy
* Breast Feeding