Current Oncology Reports

, Volume 7, Issue 4, pp 271–276

The cancer anorexia/weight loss syndrome: Therapeutic challenges

  • Karin F. Giordano
  • Aminah Jatoi
Article

Abstract

The cancer anorexia/weight loss syndrome is characterized by loss of weight, loss of appetite, overall decline in quality of life, and shortened survival in patients with advanced incurable cancer. It is highly prevalent. To date, treatment options that have been firmly established with good scientific evidence are limited to progestational agents and corticosteroids, both of which have been demonstrated to improve appetite but have otherwise failed to have a favorable impact on some of the other aspects of this syndrome. As the mechanisms behind this syndrome are further elucidated, more effective therapeutic strategies will likely emerge.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Pestalozzi BC: Looking at the dying patient: the Ferdinand Hodler paintings of Valentine Gode-Darel. J Clin Oncol 2002, 20:1948–1959.PubMedGoogle Scholar
  2. 2.
    De Wys WD, Begg C, Lavin PT, et al.: Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med 1980, 69:491–497.CrossRefGoogle Scholar
  3. 3.
    Ross PJ, Ashley S, Norton A, et al.: Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancers? Br J Cancer 2004, 90:1905–1911.PubMedCrossRefGoogle Scholar
  4. 4.
    Loprinzi CL, Laurie JA, Wieand HS, et al.: Prospective evaluation of prognostic variables from patient-completed questionnaires. J Clin Oncol 1994, 12:601–607.PubMedGoogle Scholar
  5. 5.
    Sarhill N, Mahmoud F, Walsh D, et al.: Evaluation of nutritional status in advanced metastatic cancer. Support Care Cancer 2003, 11:652–659.PubMedCrossRefGoogle Scholar
  6. 6.
    Finkelstein DM, Cassileth BR, Bonomi PD, et al.: A pilot study of the Functional Living Index-Cancer (FLIC) Scale for the assessment of quality of life for metastatic lung cancer patients. An Eastern Cooperative Oncology Group study. Am J Clin Oncol 1989, 11:630–633.CrossRefGoogle Scholar
  7. 7.
    Socinski MA, Zhang C, Herndon JE, et al.: Combined modality trials of the Cancer and Leukemia Group B in stage III nonsmall cell lung cancer: analysis of factors influencing survival and toxicity. Ann Oncol 2004, 15:1033–1041.PubMedCrossRefGoogle Scholar
  8. 8.
    Walsh D, Rybicki L, Nelson KA, Donnelly S: Symptoms and prognosis in advanced cancer. Support Care Cancer 2002, 10:385–388.PubMedCrossRefGoogle Scholar
  9. 9.
    Cohn SH, Gartenhaus W, Sawitsky A, et al.: Compartmental body composition of cancer patients by measurement of total body nitrogen, potassium, and water. Metabol Clin Exp 1981, 30:222–229.Google Scholar
  10. 10.
    Kotler DP, Tierney AR, Wang J, Pierson RN: Magnitude of body cell mass depletion and the timing of death from wasting in AIDS. Am J Clin Nutrition 1989, 50:444–7.Google Scholar
  11. 11.
    Keys A, Brozek J, Henschel A, et al.: The Biology of Human Starvation. St. Paul, MN: The University of Minnesota Press, 1950.Google Scholar
  12. 12.
    Jatoi A, Daly BD, Hughes VA, et al.: Do patients with metastatic non-small cell lung cancer demonstrate altered resting energy expenditure? Ann Thorac Surg 2001, 72:348–351.PubMedCrossRefGoogle Scholar
  13. 13.
    Baracos VE, DeVivo C, Hoyle DH, Goldberg AL: Activation of the ATP-ubiquitin-proteasome pathway in skeletal muscle of cachectic rats bearing a hepatoma. Am J Physiol 1995, 268:E996-E1006.PubMedGoogle Scholar
  14. 14.
    Lazarus DD, Destree AT, Mazzola LM, et al.: A new model of cancer cachexia: contribution of the ubiquitin-proteasome pathway. Am J Physiol 1999, 277:E332-E341.PubMedGoogle Scholar
  15. 15.
    Bossola M, Muscaritoli M, Costelli P, et al.: Increased muscle proteasome activity correlates with disease severity in gastric cancer patients. Ann Surg 2003, 237:384–389. This paper provides some of the first data on the ubiquitin-proteasome pathway in the clinical setting.PubMedCrossRefGoogle Scholar
  16. 16.
    Jatoi A, Alberts S, Foster N, et al.: Is bortezomib, a proteasome inhibitor, effective in treating cancer-associated weight loss? Preliminary results from the North Central Cancer Treatment Group. Support Care Cancer, in press.Google Scholar
  17. 17.
    Jatoi A, Egner J, Loprinzi CL, et al.: Investigating the utility of serum cytokine measurements in a multi-institutional cancer anorexia/weight loss trial. Support Care Cancer 2004, 12:640–644.PubMedCrossRefGoogle Scholar
  18. 18.
    Llovera M, Garcia-Martinez C, Lopez-Soriano J, et al.: Role of TNF receptor 1 in protein turnover during cancer cachexia using gene knockout mice. Mol Cell Endocrinol 1998, 142:183–189.PubMedCrossRefGoogle Scholar
  19. 19.
    Torelli GF, Meguid MM, Moldawer LL, et al.: Use of recombinant soluble TNF receptor in anorectic tumor-bearing rats. Am J Physiol 1999, 277 (3 Pt 2):R850-R855. This paper provides some of the most compelling preclinical data on the need to pursue clinical investigation of TNF blockade for the cancer anorexia/weight loss syndrome.PubMedGoogle Scholar
  20. 20.
    Langen RC, Van Der Velden JL, et al.: Tumor necrosis factoralpha inhibits myogenic differentiation through MyoD protein destabilization. FASEB J 2004, 18:227–237.PubMedCrossRefGoogle Scholar
  21. 21.
    Todorov P, Cariuk P, McDEvitt T, et al.: Characterization of a cancer cachectic factor. Nature 1996, 379:739–742.PubMedCrossRefGoogle Scholar
  22. 22.
    Ovesen L, Allingstrup L, Hannibal J, et al.: Effect of dietary counseling on food intake, body weight, response rate, survival, and quality of life in cancer patients undergoing chemotherapy: a prospective, randomized study. J Clin Oncol 1993, 11:2043–2049.PubMedGoogle Scholar
  23. 23.
    Ravasco P, Montiero-Grillo I, Vidal PM, Camilo ME: Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol 2005, 23:1–8.CrossRefGoogle Scholar
  24. 24.
    Loprinzi CL, Ellison NM, Schaid DJ, et al.: Controlled trial of megestrol acetate for the treatment of cancer anorexia and cachexia. J Natl Cancer Inst 1990, 82:1127–1132.PubMedCrossRefGoogle Scholar
  25. 25.
    Goldberg RM, Loprinzi CL, Mailliard JA, et al.: Pentoxifylline for treatment of cancer anorexia and cachexia? A randomized, double blind placebo-controlled trial. J Clin Oncol 1995, 13:2856–2859.PubMedGoogle Scholar
  26. 26.
    Loprinzi CL, Kugler JW, Sloan JA, et al.: Randomized comparison of megestrol acetate versus dexamethasone versus fluoxymesterone for the treatment of cancer anorexia/ cachexia. J Clin Oncol 1999, 17:3299–3306.PubMedGoogle Scholar
  27. 27.
    Kardinal CG, Loprinzi CL, Schaid DJ, et al.: A controlled trial of cyproheptadine in cancer patients with anorexia and/or cachexia. Cancer 1990, 65:2657–2662.PubMedCrossRefGoogle Scholar
  28. 28.
    Loprinzi CL, Goldberg RM, Su JO, et al.: Placebo-controlled trial of hydrazine sulfate in patients with newly diagnosed non-small cell lung cancer. J Clin Oncol 1994, 12:1126–1129.PubMedGoogle Scholar
  29. 29.
    Jatoi A, Windschitl HE, Loprinzi CL, et al.: Dronabinol versus megestrol acetate versus combination therapy for cancerassociated anorexia. J Clin Oncol 2002, 20:567–573.PubMedCrossRefGoogle Scholar
  30. 30.
    Jatoi A, Rowland K, Loprinzi CL, et al.: An eicosapentaenoic acid supplement versus megestrol acetate versus both for patients with cancer-associated wasting. J Clin Oncol 2004, 22:2469–2476.PubMedCrossRefGoogle Scholar
  31. 31.
    Jatoi A, Kumar S, Sloan J, Nguyen PL: On appetite and its loss. J Clin Oncol 2000, 18:2930–2932.PubMedGoogle Scholar
  32. 32.
    Loprinzi CL, Bernath AM, Schaid DJ, et al.: Phase III Evaluation of megestrol acetate as therapy for patients with cancer anorexia and/or cachexia. Oncology 1994, 51(Suppl 1):2–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Moertel CG, Schutt AJ, Reitemeier RJ, Hahn RG: Corticosteroid therapy of preterminal gastrointestinal cancer. Cancer 1974, 33:1607–1609.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2005

Authors and Affiliations

  • Karin F. Giordano
    • 1
  • Aminah Jatoi
    • 1
  1. 1.Department of OncologyMayo Clinic College of MedicineRochesterUSA

Personalised recommendations