Novel therapeutic options for cachexia and sarcopenia

ABSTRACT

Introduction: Cachexia and sarcopenia are conditions phenotypically characterized by muscle loss and represent a factor of poor prognosis, increasing patients’ morbidity and mortality. Cachectic and sarcopenic patients often suffer from low quality of life, presenting lower muscle strength and appetite loss, which makes research on novel treatment strategies to ameliorate clinical response including patient’s symptoms, the objective of scientific interest.

Areas covered: This article covers recent developments in the area of cachexia and sarcopenia treatment and therapeutic interventions, targeting central nervous system involvement, key inflammatory and muscle-specific metabolic pathways.

Expert opinion: A number of promising agents have being evaluated, such as enobosarm, a selected androgen receptor modulator, and anamorelin, a ghrelin agonist which have been recently studied in phase III trials. These and other agents (i.e., infliximab, tocilizumab, MABp1, bimagrumab) have shown significant impact on reversal of skeletal muscle loss, but limited effect on physical function.

In the last few years advancement in the number and type of potential treatments for cachexia and sarcopenia have been obtained and we have now available more data on measurable effects of several drugs on patients’ nutritional and metabolic parameters and outcomes.

KEYWORDS:

• Biological therapies
• cachexia
• cancer
• chronic diseases
• metabolic and nutritional pathways
• sarcopenia

Article highlights

• Cachexia and sarcopenia, causing severe muscle derangements, increase patients’ morbidity and mortality.

• Novel therapeutic strategies for the treatment of cachexia and sarcopenia are aimed at improving body composition and quality of life.

• Phase III clinical trials of anamorelin, a ghrelin agonist, and enobosarm, a selective androgen receptor modulator, have documented significant impact on increasing muscle mass in patients with cachexia.

• Targeting inflammation, through anti-cytokines/myokines therapies with or without conventional therapies, appears promising.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

There was no funding for this paper.