Department of Medical Oncology, University of Cagliari, Cagliari, Italy.
Support Care Cancer. 2010 Jan;18(1):1-9. doi: 10.1007/s00520-009-0722-3. Epub 2009 Aug 18.
Cachexia is a complex metabolic syndrome associated with many chronic or end-stage diseases, especially cancer, and is characterized by loss of muscle with or without loss of fat mass. The management of cachexia is a complex challenge that should address the different causes underlying this clinical event with an integrated or multimodal treatment approach targeting the different factors involved in its pathophysiology.
The purpose of this article was to review the current medical treatment of cancer-related cachexia, in particular focusing on combination therapy and ongoing research.
Among the treatments proposed in the literature for cancer-related cachexia, some proved to be ineffective, namely, cyproheptadine, hydrazine, metoclopramide, and pentoxifylline. Among effective treatments, progestagens are currently considered the best available treatment option for cancer-related cachexia, and they are the only drugs approved in Europe. Drugs with a strong rationale that have failed or have not shown univocal results in clinical trials so far include eicosapentaenoic acid, cannabinoids, bortezomib, and anti-TNF-alpha MoAb. Several emerging drugs have shown promising results but are still under clinical investigation (thalidomide, selective cox-2 inhibitors, ghrelin mimetics, insulin, oxandrolone, and olanzapine).
To date, despite several years of co-ordinated efforts in basic and clinical research, practice guidelines for the prevention and treatment of cancer-related muscle wasting are lacking, mainly because of the multifactorial pathogenesis of the syndrome. From all the data presented, one can speculate that one single therapy may not be completely successful in the treatment of cachexia. From this point of view, treatments involving different combinations are more likely to be successful.
恶病质是一种与许多慢性或终末期疾病相关的复杂代谢综合征，尤其是癌症，并以肌肉减少伴有或不伴有脂肪量减少为特征。恶病质的治疗是一个复杂的挑战，应该针对这种临床事件的不同原因，采用综合或多模式的治疗方法，针对其病理生理学涉及的不同因素进行治疗。
本文的目的是回顾癌症相关性恶病质的当前医学治疗方法，特别是重点关注联合治疗和正在进行的研究。
在文献中提出的癌症相关性恶病质治疗方法中，有些被证明是无效的，即赛庚啶、肼、甲氧氯普胺和己酮可可碱。在有效的治疗方法中，孕激素目前被认为是癌症相关性恶病质的最佳可用治疗选择，并且是唯一在欧洲获得批准的药物。目前具有较强理论依据但在临床试验中失败或尚未显示明确结果的药物包括二十碳五烯酸、大麻素、硼替佐米和抗 TNF-α MoAb。一些新兴药物已经显示出有希望的结果，但仍在临床研究中（沙利度胺、选择性 COX-2 抑制剂、胃饥饿素模拟物、胰岛素、氧雄龙和奥氮平）。
迄今为止，尽管在基础和临床研究方面进行了多年的协调努力，但癌症相关肌肉减少症的预防和治疗实践指南仍然缺乏，主要是因为该综合征的发病机制具有多因素性。从呈现的所有数据中，可以推测单一疗法可能不完全成功地治疗恶病质。从这一观点出发，涉及不同组合的治疗方法更有可能成功。
