Managing Cancer-Related Anorexia/Cachexia

Authors: Mantovani G.¹; Macciò A.²; Massa E.¹; Madeddu C.¹

Source: Drugs, Volume 61, Number 4, 2001 , pp. 499-514(16)

Publisher: Adis International

Abstract:

Cancer-related anorexia/cachexia (CAC) is a complex phenomenon in which metabolic abnormalities, proinflammatory cytokines produced by the host immune system, circulating tumour-derived catabolic factors, decreased food intake, and probably additional unknown factors, all play different roles.

This review examines the mechanisms of CAC and its management. All the potential modalities of intervention from nutritional to pharmacological approaches are included with a clear distinction between unproven, investigational and well established treatments. Among the latter, the progestogens are currently considered the most effective and safest drugs for the management of CAC. Agents currently under investigation for CAC include thalidomide, pentoxifylline and melatonin, which most probably act on cytokine release, and clenbuterol, which acts on muscle mass and to antagonise protein wasting.

Our personal experience with the synthetic progestogens megestrol and medroxyprogesterone supports their use as first-line agents. In addition, our work on the potential role of antioxidant agents in counteracting the oxidative stress, which appears to be involved in CAC, shows them to be promising agents when used in combination chemotherapy regimens either alone or with other ‘biologics’.

There is an ongoing need for quality of life questionnaires which specifically address the most significant symptoms present in patients with CAC.

Keywords: Anabolic steroids, therapeutic use; Anorexia, treatment; Antioxidants, therapeutic use; Beta 2 adrenoceptor agonists, therapeutic use; Cachexia, treatment; Cancer; Cannabinoids, therapeutic use; Corticosteroids, therapeutic use; Cyproheptadine, therapeutic use; Cytokine synthesis inhibitors, therapeutic use; Hydrazine, therapeutic use; Melatonin, therapeutic use; Metoclopramide, therapeutic use; Nonsteroidal anti inflammatories, therapeutic use; Omega 3 fatty acid, therapeutic use; Progestogens, therapeutic use

Language: English

Document Type: Miscellaneous

Affiliations: 1: Department of Medical Oncology, University of Cagliari, Cagliari, Italy 2: Division of Obstetrics and Gynecology, University of Cagliari, Italy *

Publication date: 2001-01-01

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• In this Subject: Pharmacology ,  Therapeutics & Alternative Medicine
• By this author: Mantovani G. ;  Macciò A. ;  Massa E. ;  Madeddu C.

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