Optimal management of cancer anorexia–cachexia syndrome

Figures & data

Figure 1 Therapeutic targets for cancer cachexia. There are different therapeutic approaches to fight anorexia and metabolic disturbances based in the combination of nutritional support, nutraceuticals and specific drugs. The objectives for cachexia treatment are two: anticatabolic (directed towards both fat and muscle) and anabolic (leading to the synthesis of macromolecules).

Figure 2 Cachexia endpoints. The monitoring of cachexia is a key issue during therapy. Different parameters in relation with anorexia and metabolic disturbances should be taken into consideration. Although bodyweight is the most important endpoint, body composition, physical performance and survival, which reflect the impact of the treatment, should also be taken into consideration and analyzed.

Abbreviation: QoL, quality of life.

Table 1 Efficiency of the different anti-cachexia treatments

Drug	Experimental animals	Humans
Progesterone derivatives	++	++
Cannabinoids	++	+
Cyproheptadine	+	+
Corticosteroids	–	–
Ghrelin	++	++
Pentoxifylline	++	?
Thalidomide	+	+
Anti-cytokine antibodies and soluble receptors	+++	–
Anti-inflammatory cytokines	++	?
Anabolic steroids	++	++
β2-adrenergic agonists	+++	?
ω-3-fatty acids	++	++
Prostaglandin inhibitors	++	+
ACE inhibitors	++	?
EPO	?	++
ATP	?	+
Creatine	?	+
Amino acids	++	+
Proteasome inhibitors	?	?

Data refer to experimental and clinical trials. +, slight beneficial effect. ++ relatively good results. +++, satisfactory treatment. –, unsuccessful trial. ?, unknown. Table adapted from Argilés et al.

Abbreviations: ACE, angiotensin-converting enzyme; EPO, erythropoietin; ATP, adenosine triphosphate.