Cancer cachexia is defined as a multifactorial syndrome characterized by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional
nutritional support and leads to progressive functional impairment. The prominent clinical feature of
cachexia is
weight loss in adults.
Anorexia,
inflammation,
insulin resistance, and increased
muscle protein breakdown frequently are associated with
cachexia. One single
therapy may not be completely successful in the treatment of
cachexia because of the complexity of the pathogenesis and symptoms of the
cachexia syndrome. Among effective treatments,
progestogens currently are considered the best available treatment option and are the only approved drugs in Europe for the treatment of
cancer- and
AIDS-related
cachexia. However, they have limited efficacy in treating
cancer cachexia. However,
thalidomide, selective
COX-2 inhibitors,
ghrelin mimetics, and selective
androgen receptor modulators showed promising results but should be defined further and confirmed in clinical trials. Therefore, to date, despite several years of coordinated efforts in basic and clinical research, the practice guidelines for the prevention and treatment of
cancer-related
anorexia cachexia syndrome (CACS) are lacking. The management of CACS is a complex challenge that should address the different causes underlying this clinical event. Recent studies showed that integrated, multitargeted approaches are more effective than single-agent approaches for the treatment of CACS. Further clinical trials to improve and refine current strategies to counteract
cancer cachexia using multimodal interventions, including nutritional supplementation,
anabolic agents, and antiinflammatory drugs along with an appropriate physical exercise program, are warranted.