Department of Medical Oncology, University of Cagliari, Italy.
Curr Opin Support Palliat Care. 2009 Dec;3(4):258-62. doi: 10.1097/SPC.0b013e3283311c6f.
There are no published conclusive phase III controlled clinical trials nor general consensus about treatment approaches despite several years of coordinated efforts in basic and clinical research. Consequently, practice guidelines for the prevention and treatment of cancer-related muscle wasting are lacking. The purpose of this review is to supply an update on the promising agents and/or combined approaches for the treatment of cancer cachexia.
The choice for cancer cachexia treatment in clinical practice is very limited: the only approved drugs in Europe are progestagens. Several drugs with a strong rationale have failed or have not shown univocal results in clinical trials: they include eicosapentaenoic acid, cannabinoids, bortezomib and anti-tumor necrosis factor (TNF)-alpha monoclonal antibody. Several emerging drugs have shown promising results but are still under clinical investigation [thalidomide, selective cyclooxygenase (COX)-2 inhibitors, ghrelin mimetics, oxandrolone, olanzapine]. Moreover, increasing knowledge of cachexia pathophysiology and preliminary clinical findings seem to suggest that a combined treatment approach may be the most effective option.
A number of promising new agents are currently being developed but are not as yet regarded as standard of care. They include: selective COX-2 inhibitors, ghrelin mimetics, oxandrolone, selective androgen receptor modulators (ostarine), olanzapine, anti-IL-6 antibody and an innovative approach of multitargeted combined treatment. The data reported seem to suggest that the most effective treatment for cancer cachexia may be a combination regimen rather than single-agent treatments. This is in keeping with the general consensus that cancer cachexia is a multifactorial process and, hence, a potentially effective approach should be multimodal.
尽管在基础和临床研究方面进行了多年的协调努力，但仍没有发表关于治疗方法的具有结论性的 III 期对照临床试验，也没有达成普遍共识。因此，缺乏预防和治疗癌症相关肌肉减少症的实践指南。本综述的目的是提供一种关于治疗癌症恶病质的有前途的药物和/或联合方法的最新信息。
在临床实践中，癌症恶病质的治疗选择非常有限：在欧洲唯一批准的药物是孕激素。几种具有强有力理论依据的药物在临床试验中失败或没有显示出明确的结果：它们包括二十碳五烯酸、大麻素、硼替佐米和抗肿瘤坏死因子（TNF）-α单克隆抗体。几种新兴药物已显示出有希望的结果，但仍在临床研究中[沙利度胺、选择性环氧化酶（COX）-2 抑制剂、生长激素释放肽类似物、氧雄龙、奥氮平]。此外，对恶病质病理生理学的深入了解和初步临床发现似乎表明，联合治疗方法可能是最有效的选择。
目前正在开发许多有前途的新药物，但尚未被视为标准治疗方法。它们包括：选择性 COX-2 抑制剂、生长激素释放肽类似物、氧雄龙、选择性雄激素受体调节剂（奥沙利酮）、奥氮平、抗 IL-6 抗体和一种创新的多靶点联合治疗方法。报告的数据似乎表明，癌症恶病质的最有效治疗方法可能是联合治疗方案，而不是单一药物治疗。这与癌症恶病质是一种多因素过程的普遍共识一致，因此，潜在有效的方法应该是多模式的。
