Meriggi Fausto
Oncology Department, Poliambulanza Foundation, Via Leonida Bissolati 57, Brescia, Italy.
Rev Recent Clin Trials. 2015;10(3):246-50. doi: 10.2174/1574887110666150916141351.
Cachexia is one of the most common manifestations in advanced cancer patients, but too often it remains under- recognized and under-treated. Starvation is not the same of cachexia. Cachexia is defined by "weight loss >5% over past 6 months in absence of simple starvation or the combination of ongoing weight loss>2% with BMI <20 or sarcopenia". The pathogenesis of cancer cachexia is not fully understood, but inflammation and an increased catabolic response to a number of cancer-related factors seem to represent the basis of any assumption. Early diagnosis of a pre-cachectic or cachectic state is a key moment for the treatment of this complex syndrome, in order to guarantee an adequate food intake and suitable exercise and to interfere with the inflammatory processes that are typical of cachexia. Therefore, one of the main aims is to identify those patients most likely to develop the syndrome early. A multimodality baseline approach to cancer cachexia addresses reversible clinical contributory factors. There are currently no medicinal products that have a proven efficacy in the medical approach to cancer cachexia. Recently, anamorelin, a synthetic orally active ghrelin receptor agonist, showed promising results, but the best approach to cancer cachexia probably remains an early multimodal interventions consisting in nutritional intervention, exercise and rehabilitation program, and multi-target drug therapies. This review summarizes what we know and what still need to know about cancer cachexia syndrome.
恶病质是晚期癌症患者最常见的表现之一，但往往未得到充分认识和治疗。饥饿与恶病质不同。恶病质的定义为“在无单纯饥饿的情况下，过去6个月体重减轻>5%，或持续体重减轻>2%且BMI<20或存在肌肉减少症”。癌症恶病质的发病机制尚未完全明了，但炎症以及对多种癌症相关因素分解代谢反应的增加似乎是任何假设的基础。恶病质前期或恶病质状态的早期诊断是治疗这种复杂综合征的关键时刻，以便保证充足的食物摄入和适当的运动，并干预恶病质典型的炎症过程。因此，主要目标之一是识别那些最有可能早期发生该综合征的患者。针对癌症恶病质的多模式基线方法可解决可逆的临床促成因素。目前在癌症恶病质的医学治疗中尚无经证实有效的药物产品。最近，一种合成的口服活性胃饥饿素受体激动剂阿那莫林显示出有前景的结果，但癌症恶病质的最佳治疗方法可能仍然是早期多模式干预，包括营养干预、运动和康复计划以及多靶点药物治疗。本综述总结了我们对癌症恶病质综合征已知和仍需了解的内容。
