Managing cancer cachexia

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Abstract

The European Palliative Care Research Collaboration (EPCRC) has developed evidence-based recommendations for the classification and treatment of cachexia in advanced cancer patients [1]. These treatment guidelines focus on patients with advanced cancer that are likely to suffer from refractory cachexia, a very serious condition especially as many of these patients are receiving palliative care and life expectancy is often short. Little cachexia-specific research has been done on this patient group and the EPCRC treatment guidelines had to consider whether research results taken from other disease stages could be applicable for patients with advanced and incurable disease with refractory cachexia [1].

Keywords

Clin Oncol Lean Body Mass Cancer Cachexia Advanced Cancer Patient American Dietetic Association 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References

  1. 1.
    Radbruch L, Elsner F, Trottenberg P, et al. Clinical practice guidelines on cancer cachexia in advanced cancer patients. Aachen: European Palliative Care Research Collective; 2010.Google Scholar
  2. 2.
    Barber MD, Ross JA, Fearon KC. Cancer cachexia. Surg Oncol. 1999;8:133-141.Google Scholar
  3. 3.
    Inui A. Cancer anorexia-cachexia syndrome: current issues in research and management. CA Cancer J Clin. 2002;52:72-91.Google Scholar
  4. 4.
    Del Fabbro E, Dalal S, Bruera E. Symptom control in palliative care-Part II: cachexia/anorexia and fatigue. J Palliat Med. 2006;9:409-421.Google Scholar
  5. 5.
    Topkan E, Yavuz AA, Ozyilkan O. Cancer cachexia: pathophysiologic aspects and treatment options. Asian Pac J Cancer Prev. 2007;8:445-451.Google Scholar
  6. 6.
    Mantovani G, Maccio A, Madeddu C, et al. Randomized phase III clinical trial of five different arms of treatment in 332 patients with cancer cachexia. Oncologist. 2010;15:200-211.Google Scholar
  7. 7.
    Tazi E, Errihani H. Treatment of cachexia in oncology. Indian J Palliat Care. 2010;16:129-137.Google Scholar
  8. 8.
    Nelson KA. The cancer anorexia-cachexia syndrome. Semin Oncol. 2000;27:64-68.Google Scholar
  9. 9.
    Gagnon B, Bruera E. A review of the drug treatment of cachexia associated with cancer. Drugs. 1998;55:675-688.Google Scholar
  10. 10.
    Argiles JM, Meijsing SH, Pallares-Trujillo J, Guirao X, Lopez-Soriano FJ. Cancer cachexia: a therapeutic approach. Med Res Rev. 2000;21:83-101.Google Scholar
  11. 11.
    Nelson K, Walsh D, Deeter P, Sheehan F. A phase II study of delta-9-tetrahydrocannabinol for appetite stimulation in cancer-associated anorexia. J Palliat Care. 1993;10:14-18.Google Scholar
  12. 12.
    Plasse TF, Gorter RW, Krasnow SH, Lane M, Shepard KV, Wadleigh RG. Recent clinical experience with dronabinol. Pharmacol Biochem Behav. 1991;40:695-700.Google Scholar
  13. 13.
    Pertwee RG. Pharmacology of cannabinoid CB1 and CB2receptors. Pharmacol Ther. 1997;74:129-180.Google Scholar
  14. 14.
    Mantovani G, Maccio A, Massa E, Madeddu C. Managing cancer-related anorexia/cachexia. Drugs. 2001;61:499-514.Google Scholar
  15. 15.
    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.Google Scholar
  16. 16.
    Meguid MM, Fetissov SO, Varma M, et al. Hypothalamic dopamine and serotonin in the regulation of food intake. Nutrition. 2000;16:843-857.Google Scholar
  17. 17.
    Laviano A, Meguid MM, Yang ZJ, Gleason JR, Cangiano C, Rossi Fanelli F. Cracking the riddle of cancer anorexia. Nutrition. 1996;12:706-710.Google Scholar
  18. 18.
    Moertel CG, Kvols LK, Rubin J. A study of cyproheptadine in the treatment of metastatic carcinoid tumor and the malignant carcinoid syndrome. Cancer. 1990;67:33-36.Google Scholar
  19. 19.
    Daviss WB, Scott J. A chart review of cyproheptadine for stimulant-induced weight loss. J Child Adolesc Psychopharmacol. 2004;14:65-73.Google Scholar
  20. 20.
    Genazzani AD, Strucchi C, Malavasi B, et al. Effects of cyproheptadine clorhydrate, a serotonin receptor antagonist, on endocrine parameters in weight-loss related amenorrhea. Gynecol Endocrinol. 2001;15:279-285.Google Scholar
  21. 21.
    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.Google Scholar
  22. 22.
    Loprinzi CL, Michalak JC, Schaid DJ, et al. Phase III evaluation of four doses of megestrol acetate as therapy for patients with cancer anorexia and/or cachexia. J Clin Oncol. 1993;11:762-767.Google Scholar
  23. 23.
    Bruera E, Macmillan K, Kuehn N, Hanson J, MacDonald RN. A controlled trial of megestrol acetate on appetite, caloric intake, nutritional status, and other symptoms in patients with advanced cancer. Cancer. 1990;66:1279-1282.Google Scholar
  24. 24.
    Feliui J, Gontalez-Baron M, Berrocal A, Ordonez A, Baron-Saura JM. Treatment of cancer anorexia with megestrol acetate: which is the optimal dose? J Natl Cancer Inst. 1991;83:449-450.Google Scholar
  25. 25.
    Tchekmedyian NSN, Hickman MM, Siau JJ, et al. Megestrol acetate in cancer anorexia and weight loss. Cancer. 1992;69:1268-1274.Google Scholar
  26. 26.
    Loprinzi CL, Schaid DJ, Dose AM, Burnham NL, Jensen MD. Body-composition changes in patients who gain weight while receiving megestrol acetate. J Clin Oncol. 1993;11:152-154.Google Scholar
  27. 27.
    Rowland KM, Loprinzi CL, Shaw EG, et al. Randomized double-blind placebo-controlled trial of cisplatin and etoposide plus megestrol acetate/placebo in extensive-stage small-cell lung cancer: a North Central Cancer Treatment Group study. J Clin Oncol. 1995;14:135-141.Google Scholar
  28. 28.
    Maltoni M, Nanni O, Scarpi E, Rossi D, Serra P, Amadori D. High-dose progestins for the treatment of cancer anorexia-cachexia syndrome: A systematic review of randomised clinical trials. Ann Oncol. 2001;12:289-300.Google Scholar
  29. 29.
    Ottery FD, Walsh D, Strawford A. Pharmacologic management of anorexia/cachexia. Semin. Oncol. 1998;25(2 Suppl 6):35-44.Google Scholar
  30. 30.
    John M. Appetite Stimulants. In: Nicholson JR, Hofbauer kg, Anker SD, Inui A, eds. Pharmacotherapy of Cachexia. London:CRC Press; 2012:291-302.Google Scholar
  31. 31.
    Kojima M, Hosoda H, Date Y, Nakazato M, Matsuo H, Kangawa K. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature. 1999;402:656-660.Google Scholar
  32. 32.
    Inui A. Ghrelin: an orexigenic and somatotrophic signal from the stomach. Nat Rev Neurosci. 2001;2:551-560.Google Scholar
  33. 33.
    Garcia J, Boccia RV, Graham C, Kumor K, Polvino W. A phase II randomized, placebo-controlled, double-blind study of the efficacy and safety of RC-1291 (RC) for the treatment of cancer cachexia. J Clin Oncol. 2007;25(June 20 Supplement):9133. ASCO website. www.asco.org/ascov2/Meetings/Abstracts?&vmview=abst_detail_view&confID=47&abstractID=36473. Accessed July 17, 2012.
  34. 34.
    Akamizu T, Kangawa K. Ghrelin for cachexia. J Cachex Sarcopenia Muscle. 2010;1:169-176.Google Scholar
  35. 35.
    Gonzalez-Rey E, Chorny A, Delgado M. Therapeutic action of ghrelin in a mouse model of colitis. Gastroenterology. 2006;130:1707-1720.Google Scholar
  36. 36.
    Waseem T, Duxbury M, Ito H, Ashley SW, Robinson MK. Exogenous ghrelin modulates release of pro-inflammatory and anti-inflammatory cytokines in LPS-stimulated macrophages through distinct signaling pathways. Surgery. 2008;143:334-342.Google Scholar
  37. 37.
    Dixit VD, Schaffer EM, Pyle RS, et al. Ghrelin inhibits leptin- and activation-induced proinflammatory cytokine expression by human monocytes and T cells. J Clin Invest. 2004;114:57-66.Google Scholar
  38. 38.
    Li WG, Gavrila D, Liu X, et al. Ghrelin inhibits proinflammatory responses and nuclear factor-κB activation in human endothelial cells. Circulation. 2004;109:2221-2226.Google Scholar
  39. 39.
    Wu R, Dong W, Zhou M, et al. Ghrelin attenuates sepsis-induced acute lung injury and mortality in rats. Am J Respir Crit Care Med. 2007;176:805-813.Google Scholar
  40. 40.
    Kumar NB, Kazi A, Smith T, et al. Cancer cachexia: traditional therapies and novel molecular mechanism-based approaches to treatment. Curr Treat Options Oncol. 2010;11:107-117.Google Scholar
  41. 41.
    Couch M, Lai V, Cannon T, et al. Cancer cachexia syndrome in head and neck cancer patients: part I. Diagnosis, impact on quality of life and survival, and treatment. Head Neck. 2007;29:401-411.Google Scholar
  42. 42.
    Fearon KCH, Meyenfeldt Von MF, Moses AGW, et al. Effect of a protein and energy dense N-3 fatty acid enriched oral supplement on loss of weight and lean tissue in cancer cachexia: a randomised double blind trial. Gut. 2003;52:1479-1486.Google Scholar
  43. 43.
    Fearon KCH. Cancer cachexia: developing multimodal therapy for a multidimensional problem. Eur J Cancer. 2008;44:1124-1132.Google Scholar
  44. 44.
    Palesty JA, Dudrick SJ. Cachexia, malnutrition, the refeeding syndrome, and lessons from Goldilocks. Surg Clin North Am. 2011;91:653-673.Google Scholar
  45. 45.
    Khan LUR, Ahmed J, Khan S, Macfie J. Refeeding syndrome: a literature review. Gastroenterol Res Pract. 2010;2011.Google Scholar
  46. 46.
    Solomon SM, Kirby DF. The refeeding syndrome: a review. J Parenter Enteral Nutr. 1990;14:90-97.Google Scholar
  47. 47.
    Sobotka L. Refeeding syndrome. In, Sobotka L, Allison SP, Furst P, Meier R, Pertkiewicz M, Soeters P, eds. Basics in clinical nutrition. 3rd edn. Prague: Galen; 2004:288-291.Google Scholar
  48. 48.
    Ardies CM. Exercise, cachexia, and cancer therapy: a molecular rationale. Nutr Cancer. 2001;42:143-157.Google Scholar
  49. 49.
    al-Majid S, McCarthy DO. Cancer-induced fatigue and skeletal muscle wasting: the role of exercise. Biol Res Nurs. 2001;2:186-197.Google Scholar
  50. 50.
    Doyle CC, Kushi LHL, Byers TT, et al. Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin. 2005;56:323-353.Google Scholar
  51. 51.
    Strasser F. Eating-related disorders in patients with advanced cancer. Support Care Cancer. 2003;11:11-20.Google Scholar
  52. 52.
    Ravasco P, Monteiro Grillo I, Camilo M. Cancer wasting and quality of life react to early individualized nutritional counseling. Clin Nutr. 2007;26:7-15.Google Scholar
  53. 53.
    Whitman MM. The starving patient: supportive care for people with cancer. Clin J Oncol Nurs. 2000;4:121-125.Google Scholar
  54. 54.
    Jenns K. Importance of nausea. Cancer Nurs. 1994;17:488-493.Google Scholar
  55. 55.
    Smith GF, Toonen TR. Primary care of the patient with cancer. Am Fam Physician. 2007;75:1207-1214.Google Scholar
  56. 56.
    Hesketh PJ, Kris MG, Grunberg SM, et al. Proposal for classifying the acute emetogenicity of cancer chemotherapy. J Clin Oncol. 1997;15:103-109.Google Scholar
  57. 57.
    Hesketh PJ, Gandara DR. Serotonin antagonists: a new class of antiemetic agents. J Natl Cancer Inst. 1991;83:613-620.Google Scholar
  58. 58.
    Koeller J, Aapro M, Gralla R, et al. Antiemetic guidelines: creating a more practical treatment approach. Support Care Cancer. 2002;10:519-522.Google Scholar
  59. 59.
    Grunberg SM, Koeller JM. Palonosetron: a unique 5-HT3-receptor antagonist for the prevention of chemotherapy-induced emesis. Expert Opin Pharmacother. 2012;4:2297-2303.Google Scholar
  60. 60.
    McNulty R. Are all 5-HT3 receptor antagonists the same? J Natl Compr Canc Netw. 2007;5:35-43.Google Scholar
  61. 61.
    Eisenberg PP, Figueroa-Vadillo JJ, Zamora RR, et al. Improved prevention of moderately emetogenic chemotherapy-induced nausea and vomiting with palonosetron, a pharmacologically novel 5-HT3 receptor antagonist: results of a phase III, single-dose trial versus dolasetron. Cancer. 2003;98:2473-2482.Google Scholar
  62. 62.
    Roila F, Tonato M, Cognetti F, et al. Prevention of cisplatin-induced emesis: a double-blind multicenter randomized crossover study comparing ondansetron and ondansetron plus dexamethasone. J Clin Oncol. 1991;9:675-678.Google Scholar
  63. 63.
    Hesketh PJ, Grunberg SM, Gralla RJ, et al. The oral neurokinin-1 antagonist aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a multinational, randomized, double-blind, placebo-controlled trial in patients receiving high-dose cisplatin-the Aprepitant Protocol 052 Study Group. J Clin Oncol. 2003;21:4112-4119.Google Scholar
  64. 64.
    de Wit R, Herrstedt J, Rapoport B, et al. The oral NK(1) antagonist, aprepitant, given with standard antiemetics provides protection against nausea and vomiting over multiple cycles of cisplatin-based chemotherapy: a combined analysis of two randomised, placebo-controlled phase III clinical trials. Eur J Cancer. 2004;40:403-410.Google Scholar
  65. 65.
    Balducci L, Hardy CL, Lyman GH. Hematopoietic growth factors in the older cancer patient. Curr Opin Hematol. 2001;8:170-287.Google Scholar
  66. 66.
    Bodey GP, Buckley M, Sathe YS, Freireich EJ. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med. 1966;64:328-340.Google Scholar
  67. 67.
    Sullivan DH, Walls RC. Impact of nutritional status on morbidity in a population of geriatric rehabilitation patients. J Am Geriatr Soc. 1994;42:471-477.Google Scholar
  68. 68.
    Sullivan DH. Impact of nutritional status on health outcomes of nursing home residents. J Am Geriatr Soc. 1995;43:195-196.Google Scholar
  69. 69.
    Sullivan DH, Walls RC, Bopp MM. Protein-energy undernutrition and the risk of mortality within one year of hospital discharge: a follow-up study. J Am Geriatr Soc. 1995;43:507-512.Google Scholar
  70. 70.
    Sullivan DH. The role of nutrition in increased morbidity and mortality. Clin Geriatr Med. 1995;11:661-674.Google Scholar
  71. 71.
    Thomas DR, Ashmen W, Morley JE, Evans WJ. Nutritional management in long-term care: development of a clinical guideline. Council for Nutritional Strategies in Long-Term Care. J Gerontol A Biol Sci Med Sci. 2000;55:M725-M734.Google Scholar
  72. 72.
    Bastow M, Rawlings J, Allison S. Benefits of supplementary tube feeding after fractured neck of femur: a randomised controlled trial. Br Med J. 1983;287:1589-1592.Google Scholar
  73. 73.
    Woo J, Ho SC, Mak YT, Law LK, Cheung A. Nutritional status of elderly patients during recovery from chest infection and the role of nutritional supplementation assessed by a prospective randomized single-blind trial. Age Ageing. 1994;23:40-48.Google Scholar
  74. 74.
    McMurtry CT, Rosenthal A. Predictors of 2-year mortality among older male veterans on a geriatric rehabilitation unit. J Am Geriatr Soc. 1995;43:1123-1126.Google Scholar
  75. 75.
    Yeh SS, Schuster MS. Cachexia And Wasting: A Modern Approach. Milan: Springer; 2006: 701-717.Google Scholar
  76. 76.
    Brinksma A, Huizinga G, Sulkers E, Kamps W, Roodbol P, Tissing W. Malnutrition in childhood cancer patients: A review on its prevalence and possible causes. Crit Rev Oncol Hematol. 2012;83:249-275.Google Scholar
  77. 77.
    Cole TJ. Assessment of growth. Best Pract Res Clin Endocrinol Metab. 2002;16:383-398.Google Scholar
  78. 78.
    Wilcox WD, Nieburg P, Miller DS. Failure to thrive. A continuing problem of definition. Clin Pediatr (Phila). 1989;28:391-394.Google Scholar
  79. 79.
    Jolley CD. Failure to thrive. Current Probl Pediatr Adolesc Health Care. 2003;33:183-206.Google Scholar
  80. 80.
    Lai J-S, Cella D, Goldman S. Anorexia/cachexia-related quality of life for children with cancer. Cancer. 2005;104:1531-1539.Google Scholar

Copyright information

© Springer Healthcare 2012

Authors and Affiliations

  • Egidio Del Fabbro
    • 1
  • Akio Inui
    • 2
  • Florian Strasser
    • 3
  1. 1.Massey Cancer CenterVirginia Commonwealth UniversityRichmondUSA
  2. 2.Psychosomatic Internal MedicineKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
  3. 3.Department of Internal MedicineCantonal HospitalSt GallenSwitzerland

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