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The syndrome of anorexia-cachexia
1Supportive Care Clinic, Institut Jules Bordet, Brussels, Belgium.
Current Opinion in Oncology
|July 23, 1999
Summary
Cancer anorexia and cachexia involve complex mechanisms beyond simple starvation, with cytokines playing a key role. Early nutritional support is crucial for prevention, as current treatments for cancer cachexia show limited efficacy.
Area of Science:
- Oncology
- Metabolic Medicine
- Clinical Nutrition
Background:
- Cancer anorexia/cachexia is a significant clinical issue in advanced cancer.
- Pathogenesis is complex, involving preferential fat and skeletal muscle mobilization, unlike simple starvation.
- Increased basal energy expenditure and a chronic inflammatory state mediated by cytokines (e.g., tumor necrosis factor alpha) contribute.
Purpose of the Study:
- To review the pathogenesis and management of cancer anorexia/cachexia.
- To emphasize the importance of early nutritional intervention.
- To evaluate current treatment modalities and future directions.
Main Methods:
- Literature review of cancer cachexia pathogenesis and treatment.
- Analysis of randomized controlled trials on nutritional support and pharmacologic interventions.
- Discussion of cytokine involvement and inflammatory pathways.
Main Results:
- Cancer cachexia differs from starvation by simultaneous fat and muscle loss.
- Cytokines, particularly tumor necrosis factor alpha, are central to the syndrome.
- Parenteral nutrition has not shown survival benefits; enteral nutrition (e.g., percutaneous endoscopic gastrostomy) is preferred when possible.
- Progestational drugs offer modest appetite stimulation but pharmacologic treatment remains disappointing.
- Anticytokine therapies warrant further investigation.
Conclusions:
- Prevention through early nutritional support is more effective than treatment.
- The gut should be utilized for nutrition whenever feasible.
- Pharmacologic interventions for cancer cachexia are currently limited, highlighting the need for novel therapeutic strategies, potentially targeting cytokine pathways.