Mirtazapine for Treatment of Cancer Associated Anorexia-cachexia

Inclusion Criteria: * Patients with confirmed advanced cancer. * Patients with appetite score equal or more than 4 on a 0 to 10 scale (10 \_ worst appetite). * Patients with weight loss more than 5 % of body weight over 6 months . Or : Patients with any degree of weight loss more than 2 % associated with BMI ( body mass index ) of less than 20. * Patients able to take pills orally and not dependent on tube feeding (no oral mucosal inflammation interfering with oral intake or dysphagia as determined by clinical examination). * Eastern Cooperative Oncology Group (ECOG) performance status of 0-2. * Normal organ function (creatinine ≤2× upper limit of normal, bilirubin ≤2; upper limit of normal). * Ability to understand and willingness to sign written informed consent. * Patients could be receiving concurrent chemotherapy or radiation therapy. * Patients with an expected life span of at least 3 months. Exclusion Criteria: * Patients with weight gain for known cause , e.g. , ascites. * Premenopausal women with childbearing potential with a positive pregnancy test. * Patients unable to maintain oral intake . * Patients with dementia or delirium. * Patients with uncontrolled symptoms that could impact appetite or caloric intake such as nausea, pain, or depression will be excluded until their symptoms had stabilized for at least 2 weeks. * Because improvement in anorexia and/or weight in depressed individuals could be due to an antidepressant effect of mirtazapine, rather than to …