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Emerging treatments, current challenges, and future directions

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Cancer Cachexia

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Abstract

Patients with cancer cachexia often have a high symptom burden with many unmet treatment needs. Unfortunately, although between 60–80% of patients with cancer experience poor appetite and loss of weight, health care providers infrequently assess appetite or weight [1]. Identifying patients at an early stage of cachexia will be one of the great challenges if effective future therapies are to be implemented into clinical care. Health care providers require education in order to implement behavioral changes and improve the use of systematic screening tools. As an example, implementation of the malnutrition universal screening tool (MUST) has been shown to be feasible for different health care providers and can be integrated into outpatient oncology care with the proper training [1]. Another tool, the patient-generated subjective global assessment (PG-SGA), has been shown to be easy and effective for oncology inpatients and has been endorsed by the American Dietetic Association (ADA) [2,3].

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References

  1. Boleo-Tome C, Chaves M, Monteiro-Grillo I, Camilo M, Ravasco P. Teaching nutrition integration: MUST screening in cancer. Oncologist. 2011;16:239-245.

    Google Scholar 

  2. McCallum PD, Polisena CG. The clinical guide to oncology nutrition. Chicago, IL: American Dietetic Association; 2000.

    Google Scholar 

  3. Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr. 2002;56:779-785.

    Google Scholar 

  4. Hiura Y, Takiguchi S, Yamamoto K, et al. Effects of ghrelin administration during chemotherapy with advanced esophageal cancer patients: A prospective, randomized, placebo-controlled phase 2 study. Cancer. 2012;[Epub ahead of print].

    Google Scholar 

  5. Lundholm K, Gunnebo L, Korner U, et al. Effects by daily long term provision of ghrelin to unselected weight-losing cancer patients: a randomized double-blind study. Cancer. 2010;116:2044-2052.

    Google Scholar 

  6. Nagaya N, Itoh T, Murakami S, et al. Treatment of cachexia with ghrelin in patients with COPD. Chest. 2005;128:1187-1193.

    Google Scholar 

  7. Nagaya N, Moriya J, Yasumura Y, et al. Effects of ghrelin administration on left ventricular function, exercise capacity, and muscle wasting in patients with chronic heart failure. Circulation. 2004;110:3674-3679.

    Google Scholar 

  8. 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 

  9. Wren AM, Seal LJ, Cohen MA, et al. Ghrelin enhances appetite and increases food intake in humans. J Clin Endocrinol Metab. 2001;86:5992.

    Google Scholar 

  10. Tschop M, Smiley DL, Heiman ML. Ghrelin induces adiposity in rodents. Nature. 2000;407:908-913.

    Google Scholar 

  11. 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 

  12. Greenwood-Van Meerveld B, Kriegsman M, Nelson R. Ghrelin as a target for gastrointestinal motility disorders. Peptides. 2011;32:2352-2356.

    Google Scholar 

  13. Inui A, Asakawa A, Bowers CY, et al. Ghrelin, appetite, and gastric motility: the emerging role of the stomach as an endocrine organ. FASEB. 2004;18:439-456.

    Google Scholar 

  14. Stenholm S, Metter EJ, Roth GS, et al. Relationship between plasma ghrelin, insulin, leptin, interleukin 6, adiponectin, testosterone and longevity in the Baltimore Longitudinal Study of Aging. Aging Clin Exp Res. 2011;23:153-158.

    Google Scholar 

  15. Cummings DE, Weigle DS, Frayo RS, et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med. 2002;346:1623-1630.

    Google Scholar 

  16. Soriano-Guillen L, Barrios V, Campos-Barros A, Argente J. Ghrelin levels in obesity and anorexia nervosa: effect of weight reduction or recuperation. J Pediatr. 2004;144:36-42.

    Google Scholar 

  17. Garcia JM, Garcia-Touza M, Hijazi RA, et al. Active ghrelin levels and active to total ghrelin ratio in cancer-induced cachexia. J Clin Endocrinol Metab. 2005;90:2920-2926.

    Google Scholar 

  18. Neary NM, Small CJ, Wren AM, et al. Ghrelin increases energy intake in cancer patients with impaired appetite: acute, randomized, placebo-controlled trial. J Clin Endocrinol Metab. 2004;89:2832-2836.

    Google Scholar 

  19. Strasser F, Lutz TA, Maeder MT, et al. Safety, tolerability and pharmacokinetics of intravenous ghrelin for cancer-related anorexia/cachexia: a randomised, placebo-controlled, double-blind, double-crossover study. Br J Cancer. 2008;98:300-308.

    Google Scholar 

  20. Garcia JM, Polvino WJ. Effect on body weight and safety of RC-1291, a novel, orally available ghrelin mimetic and growth hormone secretagogue: results of a phase I, randomized, placebo-controlled, multiple-dose study in healthy volunteers. Oncologist. 2007;12:594-600.

    Google Scholar 

  21. Garcia J, Boccia RV, Graham C, et al. A phase II randomized, placebo-controlled, double-blind study of the efficacy and safety of RC-1291 (RC) for the treatment of cancer cachexia [Abstract 9133]. J Clin Oncol. 2007;25:525S.

    Google Scholar 

  22. Safety and Efficacy of Anamorelin HCl in Patients With Non-Small Cell Lung Cancer-Cachexia (ROMANA 1). http://clinicaltrials.gov/ct2/show/NCT01387269. Accessed July 23, 2012.

  23. Hanada T, Toshinai K, Kajimura N, et al. Anti-cachectic effect of ghrelin in nude mice bearing human melanoma cells. Biochem Biophys Res Commun. 2003;301:275-227.

    Google Scholar 

  24. 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 for the treatment of cancer-cachexia. J Clin Oncol. 2007;25:9133.

    Google Scholar 

  25. Mohler ML, Bohl CE, Jones A, et al. Nonsteroidal selective androgen receptor modulators (SARMs): dissociating the anabolic and androgenic activities of the androgen receptor for therapeutic benefit. J Med Chem. 2009;52:3597-3617.

    Google Scholar 

  26. Bhasin S, Jasuja R. Selective androgen receptor modulators as function promoting therapies. Curr Opin Clin Nutr Metab Care. 2009;12:232-240.

    Google Scholar 

  27. Evans WJ, Smith MR, Morley JE, et al. Ostarine increases lean body mass and improves physical performance in healthy elderly subjects: implications for cancer cachexia patients J Clin Oncol. 2007;25:522S.

    Google Scholar 

  28. Dodson S, Baracos VE, Jatoi A, et al. Muscle wasting in cancer cachexia: clinical implications, diagnosis, and emerging treatment strategies. Annu Rev Med. 2011;62:265-279.

    Google Scholar 

  29. Kollias HD, McDermott JC. Transforming growth factor-beta and myostatin signaling in skeletal muscle. J Appl Physiol. 2008;104:579-587.

    Google Scholar 

  30. Jespersen J, Kjaer M, Schjerling P. The possible role of myostatin in skeletal muscle atrophy and cachexia. Scand J Med Sci Sports. 2006;16:74-82.

    Google Scholar 

  31. Elkina Y, von Haehling S, Anker SD, Springer J. The role of myostatin in muscle wasting: an overview. J Cachexia Sarcopenia Muscle. 2011;2:143-151.

    Google Scholar 

  32. Murphy KT, Chee A, Gleeson BG, et al. Antibody-directed myostatin inhibition enhances muscle mass and function in tumor-bearing mice. Am J Physiol Regul Integr Comp Physiol. 2011;301:R716-R726.

    Google Scholar 

  33. Bruera E, Neumann CM, Pituskin E, Calder K, Ball G, Hanson J. Thalidomide in patients with cachexia due to terminal cancer: preliminary report. Ann Oncol. 1999;10:857-859.

    Google Scholar 

  34. Davis M, Lasheen W, Walsh D, Mahmoud F, Bicanovsky L, Lagman R. A Phase II dose titration study of thalidomide for cancer-associated anorexia. J Pain Symptom Manage. 2012;43:78-86.

    Google Scholar 

  35. 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;15:200-201

    Google Scholar 

  36. Gordon JN, Trebble TM, Ellis RD, Duncan HD, Johns T, Goggin PM. Thalidomide in the treatment of cancer cachexia: a randomised placebo controlled trial. Gut. 2005;54:540-545.

    Google Scholar 

  37. Wilkes EA, Selby AL, Cole AT, Freeman JG, Rennie MJ, Khan ZH. Poor tolerability of thalidomide in end-stage oesophageal cancer. Eur J Cancer Care (Engl). 2011;20:593-600.

    Google Scholar 

  38. Glasner A, Avraham R, Rosenne E, et al. Improving survival rates in two models of spontaneous postoperative metastasis in mice by combined administration of a beta-adrenergic antagonist and a cyclooxygenase-2 inhibitor. J Immunol. 2010;184:2449-2457.

    Google Scholar 

  39. Bayliss TJ, Smith JT, Schuster M, Dragnev KH, Rigas JR. A humanized anti-IL-6 antibody (ALD518) in non-small cell lung cancer. Expert Opin Biol Ther. 2011;11:1663-1668.

    Google Scholar 

  40. Jatoi A, Dakhil SR, Nguyen PL, et al. Placebo-controlled double blind trial of etanercept for the cancer anorexia/weight loss syndrome: results from N00C1 from the North Central Cancer Treatment Group. Cancer. 2007;110:1396-1403.

    Google Scholar 

  41. Ovesen L, Allingstrup L, Hannibal J, Mortensen EL, Hansen OP. Effect of dietary counseling on food intake, body weight, response rate, survival, and quality of life in cancer patients undergoing chemotherapy: a prospective, randomized study. J Clin Oncol. 1993;11:2043-2049.

    Google Scholar 

  42. Evans WK, Nixon DW, Daly JM, et al. A randomized study of oral nutritional support versus ad lib nutritional intake during chemotherapy for advanced colorectal and non-small-cell lung cancer. J Clin Oncol. 1987;5:113-124.

    Google Scholar 

  43. Ravasco P, Montiero-Grillo I, Vidal P, Camilo M. Impact of nutrition on outcome: A prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck. 2005;8:659-668.

    Google Scholar 

  44. Ravasco P, Montiero-Grillo I, Vidal P, Camilo M. Dietary counseling improves patient outcomes: A prospective randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol. 2005;23:1431-1438.

    Google Scholar 

  45. American Dietetic Association. Oncology evidence-based nutrition practice guideline. Executive summary of recommendations. ADA Website. www.adaevidencelibrary.com/topic.cfm?cat=3250. Accessed July 23, 2012.

  46. Jatoi A, Windschitl HE, Loprinzi CL, et al. Dronabinol versus megestrol acetate versus combination therapy for cancer-associated anorexia: a North Central Cancer Treatment Group study. J Clin Oncol. 2002;20:567-573.

    Google Scholar 

  47. Persson C, Glimelius B, Ronnelid J, Nygren P. Impact of fish oil and melatonin on cachexia in patients with advanced gastrointestinal cancer: a randomized pilot study. Nutrition. 2005;21:170-178.

    Google Scholar 

  48. ClinicalTrials.gov. Bethesda, MD: National Library of Medicine (US). Identifier: NCT01136083. Effect of Exercise Training on Angiogenesis and Cachexia in Lung Cancer Patients. http://clinicaltrials.gov/ct2/show/NCT01136083. Accessed August 17, 2012.

  49. ClinicalTrials.gov. Bethesda, MD: National Library of Medicine (US). Identifier: NCT01419145. A Feasibility Study of Multimodal Exercise/Nutrition/Anti-inflammatory Treatment for Cachexia - the Pre-MENAC Study. http://clinicaltrials.gov/ct2/show/NCT01419145. Accessed August 17, 2012.

  50. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363:733-742.

    Google Scholar 

  51. Fortunati N, Manti R, Birocco N, et al. Proinflammatory cytokines and oxidative stress/antioxidant parameters characterize the bio-humoral profile of early cachexia in lung cancer patients. Oncol Rep. 2007;18:1521-1527.

    Google Scholar 

  52. Tan BH, Deans DA, Skipworth RJ, Ross JA, Fearon KC. Biomarkers for cancer cachexia: is there also a genetic component to cachexia? Support Care Cancer. 2008;16:229-234.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA

    Egidio Del Fabbro

  2. Psychosomatic Internal Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Kagoshima, Japan

    Akio Inui

  3. Department of Internal Medicine, Cantonal Hospital, St Gallen, St. Gallen, Switzerland

    Florian Strasser

Authors
  1. Egidio Del Fabbro
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  2. Akio Inui
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  3. Florian Strasser
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Correspondence to Egidio Del Fabbro .

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Del Fabbro, E., Inui, A., Strasser, F. (2012). Emerging treatments, current challenges, and future directions. In: Cancer Cachexia. Springer Healthcare, Tarporley. https://doi.org/10.1007/978-1-910315-07-1_6

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  • DOI: https://doi.org/10.1007/978-1-910315-07-1_6

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  • Publisher Name: Springer Healthcare, Tarporley

  • Print ISBN: 978-1-910315-06-4

  • Online ISBN: 978-1-910315-07-1

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