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Cancer Anorexia-Cachexia Syndrome Current Issues in Research and Management

Akio Inui, MD, PhD

Cachexia is among the most debilitating and life-threatening aspects of cancer. Associated with anorexia, fat and muscle tissue wasting, psychological distress, and a lower quality of life, cachexia arises from a complex interaction between the cancer and the host.

This process includes cytokine production, release of lipid-mobilizing and proteolysis-inducing factors, and alterations in intermediary metabolism. Cachexia should be suspected in patients with cancer if an involuntary weight loss of greater than five percent of premorbid weight occurs within a six-month period.

The two major options for pharmacological therapy have been either progestational agents, such as megestrol acetate, or corticosteroids. However, knowledge of the mechanisms of cancer anorexia-cachexia syndrome has led to, and continues to lead to, effective therapeutic interventions for several aspects of the syndrome.

These include antiserotonergic drugs, gastroprokinetic agents, branched-chain amino acids, eicosapentanoic acid, cannabinoids, melatonin, and thalidomide—all of which act on the feeding-regulatory circuitry to increase appetite and inhibit tumor-derived catabolic factors to antagonize tissue wasting and/or host cytokine release.

Because weight loss shortens the survival time of cancer patients and decreases performance status, effective therapy would extend patient survival and improve quality of life.

(CA Cancer J Clin 2002;52:72-91.)

Dr. Inui is Associate Professor, Division of Diabetes, Digestive, and Kidney Diseases, Department of Clinical Molecular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.

The author is indebted to Prof. Masato Kasuga and Prof. Shigeaki Baba, both of Kobe University Graduate School of Medicine, Kobe, Japan, for many stimulating discussions.

The work was supported by grants from the Ministry of Education, Science, Sports, and Culture of Japan.


Intro-What is Cachexia

Cancer J, 4/02

Hypercaloric Feeding-Omega-3 Helpful

Cancer J, 4/02

Branched-chain Amino Acids

Cancer J, 4/02

Eicosapentanoic Acid -Fish Oil

Cancer J, 4/02

Question on Study of Fish Oil, & Cachexia
EPA, Protein, Amino Acids w/Cachexia
Cannabinoids

Cancer J, 4/02 Excerpts from article on Cancer Anorexia-Cachexia

Melatonin

Excerpts from Cancer J, 4/02 Cancer Anorexia-Cachexia

Other agents including Hydrazine Sulfate

Excerpted from Cancer J, 4/02

Nutrititional, Psychological & Behavioral Therapies

Excerpts from Cancer J, 4/02

Complete References for Main Article ABOVE

CA Cancer J Clin 2002;52:72-91

Cachexia in Cancer Patients

Nature Reviews Cancer, 11/02

Definition of cancer cachexia
Caxechia & Oxidative Stress

Abstract #B198 Frontiers in Cancer Prevention Res, 2003

Celecoxib, Medroxyprogesterone, Dietary :Lung Ca

J Pain Symptom Manage, 1/04

Cancer Patients, Nutrition, Wasting,

Associated Press article 4/09/02

EPA Halts Cachexia Weight Loss
Fish Oil and Wasting (Cachexia)
Nutrition Intervention in Cancer Cachexia
Cancer Anorexia-Cachexia Syndrome - Summary & Fish Oil
Hydrazine Sulfate Influence on Nutritional Status/Survival NSCLC

J Clin Onc, 1990

Placebo-controlled Trial Hydrazine Sulfate NSCLC
Randomized Placebo-controlled Hydrazine Sulfate Colon Ca
Cancer & Leukemia Group B Study of Hydrazine Sulfate
Alternative Cancer Cures: "Unproven" or "Disproved"?
Yo-Yo Dieting Weakens Immune System

J Am Dietetic Assoc, 6/04

Pathogenesis & Treatment: Cachexia in Aged Pts

Nippon Ronen Igakkai Zasshi, 9/04

Cachexia, Oxidative Stress, Antioxidants, Pharmaco-nutrition Ova

AACR 2005 Abstract #5770


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