Advances in pharmacologic strategies for cancer cachexia.
BACKGROUND
Cancer cachexia is a severe inflammatory metabolic syndrome accounting for fatigue, an impairment of normal activities and, eventually, death. The loss of muscle mass associated with body weight loss is the main feature of this syndrome.


METHODS
The present review aims to describe the advances in the pharmacological approaches for cancer cachexia, highlighting the impact on weight loss, muscle wasting and related outcomes.


CONCLUSIONS
Among the pharmacological agents, attention should yet be given to the currently most widely studied drugs, such as progestogens and NSAIDs. Emerging drugs, such as ghrelin and selective androgen receptor modulators, have obtained promising results in recent randomized clinical trials. Larger sample sizes and more robust data on the effectiveness of anti-cytokine agents are needed. Any pharmacological approach to counteract cancer cachexia should always be associated with an adequate caloric intake, obtained by diet or through enteral or parenteral supplementation, if indicated. Finally, we can currently state that a combined approach that simultaneously targets the fundamental pathways involved in the pathogenesis of cancer cachexia is likely to be the most effective in terms of improvements in body weight as well as muscle wasting, function, physical performance and quality of life.
a 1 University of Cagliari, AOU Cagliari, Department of Medical Sciences M. Aresu , Cagliari, Italy.
Clelia
C
Madeddu
b 2 University of Cagliari, AOU Cagliari, Department of Medical Sciences M. Aresu , Via Catalani 1b, 09100 Cagliari, Italy mantovan@medicina.unica.it.
Giovanni
G
Mantovani
c 3 N.S. Bonaria Hospital, Medical Oncology Unit , San Gavino, Italy.
Giulia
G
Gramignano
d 4 A. Businco Hospital, Regional Referral Center for Cancer Diseases, Department of Gynecologic Oncology , Cagliari, Italy.
Antonio
A
Macciò
D000596:Amino Acids / Q000627:therapeutic use; D001835:Body Weight / Q000187:drug effects; D002100:Cachexia / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D002331:Carnitine / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D016207:Cytokines / Q000037:antagonists & inhibitors; D019587:Dietary Supplements; D004359:Drug Therapy, Combination; D015118:Eicosapentaenoic Acid / Q000627:therapeutic use; D005221:Fatigue / Q000209:etiology; D006801:Humans; D009369:Neoplasms / Q000150:complications* / Q000503:physiopathology; D011372:Progestins / Q000627:therapeutic use; D011788:Quality of Life; D013256:Steroids / Q000627:therapeutic use
D000596:Amino Acids; D016207:Cytokines; D011372:Progestins; D013256:Steroids; D015118:Eicosapentaenoic Acid; D002331:Carnitine
cachexia; combined approach; ghrelin; inflammation; muscle wasting; weight loss