Cachexia in Cancer Patients

Steroids have commonly been prescribed for patients with cachexia due to their effect on stimulating appetite. However, steroids do not affect ongoing weight loss, and have a number of adverse effects. Since steroids make some patients feel better, they have a role in the palliative care of advanced cancer patients.

Fish oil and eicosapentaenoic acid preparations 5

Eicosapentaenoic acid is an omega-3 fatty acid found in large concentrations in fish oil. This compound appears to stabilize body weight by inhibiting the production of proteolysis-inducing factor and interleukin-6, and in the stabilization of the acute phase protein response. Patients tolerate fish oil better than the pure acid preparation, and appetite is significantly improved. This is one of the most promising treatments for cachexia.

Combination treatment 2

Megestrol and medroxyprogesterone are synthetic compounds that have activity in the progestational phase of the menstrual cycle. These compounds stimulate appetite in cancer patients, but any weight gain appears to consist of only fat and water. Non-steroidal anti-inflammatory drugs (NSAIDS) such as Ibuprofen reduce the levels of acute phase proteins, and may increase survival time of patients. A new treatment approach is to combine the complimentary effects of progestational agents with NSAIDS.

References

1. Baldwin, A., et. al. Molecular mechanism behind skeletal muscle decay in cachexia elucidated. Science, Vol. 289, pages 2293-2294, 2350-2354, 2363-2366 (September 29, 2000).

2. Barber, M. Advances in the management of tumor-induced weight loss. Medscape, August 29, 2002.

3. Cabal-Manzano, R.,et. al. Gastro-intestinal tumor expression of proteolysis-inducing factor linked to weight loss. British Journal of Cancer, Volume 84, pages 1599-1601 (2001).

4. Rogers, B. General weight loss in cancer patients: an approach to assessment and care. Medscape, August 29, 2002.

5. Tisdale, M. Cachexia in cancer patients. Nature Reviews Cancer, Volume 2, Number 11, pages 862-971 (November, 2002).

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