Cancer cachexia: developing multimodal therapy for a multidimensional problem.
Cancer cachexia is a multi-factorial syndrome that encompasses a spectrum from early weight loss (pre-cachexia) to a state of severe incapacity incompatible with life. The molecular basis of the syndrome in animal models (based on host-tumour cell interaction, the neuro-hormonal control of appetite and the hypertrophy/atrophy pathways that govern muscle-wasting) has provided a new raft of biomarkers and therapeutic targets. Key defining features of cachexia in humans (weight loss, reduced food intake and systemic inflammation) now provide not only a framework for classification but also a rationale for targets for therapeutic intervention. The role of age and immobility in muscle-wasting also provides a rationale for the nature of nutritional support in cachexia. There is now a substantive evidence that multimodal approaches that address these key issues can stabilise and even improve the nutritional status, function and quality of life of at least a proportion of advanced cancer patients. Novel biomarkers for patient stratification and more specific techniques for the estimation of muscle mass and physical activity level herald a new era in trial design. The current evidence-base justifies new enthusiasm for the design of complex intervention studies in the management of cancer cachexia.
Fearon
K C H
KC
Clinical and Surgical Sciences (Surgery), School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, 51 Little France Crescent, Edinburgh, United Kingdom. k.fearon@ed.ac.uk
D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002100:Cachexia / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015444:Exercise / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000502:physiology; D009133:Muscular Atrophy / Q000175:diagnosis / Q000209:etiology; D009369:Neoplasms / Q000150:complications* / Q000401:mortality; D011506:Proteins / Q000378:metabolism; D011788:Quality of Life
D015415:Biomarkers; D011506:Proteins