Abstract
Cancer cachexia is a multi-factorial syndrome that encompasses a spectrum from early
weight loss (pre-cachexia) to a state of severe incapacity incompatible with life.
The molecular basis of the syndrome in animal models (based on host–tumour cell interaction,
the neuro-hormonal control of appetite and the hypertrophy/atrophy pathways that govern
muscle-wasting) has provided a new raft of biomarkers and therapeutic targets. Key
defining features of cachexia in humans (weight loss, reduced food intake and systemic
inflammation) now provide not only a framework for classification but also a rationale
for targets for therapeutic intervention. The role of age and immobility in muscle-wasting
also provides a rationale for the nature of nutritional support in cachexia. There
is now a substantive evidence that multimodal approaches that address these key issues
can stabilise and even improve the nutritional status, function and quality of life
of at least a proportion of advanced cancer patients. Novel biomarkers for patient
stratification and more specific techniques for the estimation of muscle mass and
physical activity level herald a new era in trial design. The current evidence-base
justifies new enthusiasm for the design of complex intervention studies in the management
of cancer cachexia.
Keywords
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Article info
Publication history
Published online: March 31, 2008
Accepted:
February 25,
2008
Received:
February 5,
2008
Identification
Copyright
© 2008 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
