Aversa Zaira, Costelli Paola, Muscaritoli Maurizio
Department of Clinical Medicine, Sapienza University of Rome, Italy.
Department of Clinical and Biological Sciences, University of Turin, Italy.
Ther Adv Med Oncol. 2017 May;9(5):369-382. doi: 10.1177/1758834017698643. Epub 2017 Mar 8.
Cancer cachexia is a severe and disabling clinical condition that frequently accompanies the development of many types of cancer. Muscle wasting is the hallmark of cancer cachexia and is associated with serious clinical consequences such as physical impairment, poor quality of life, reduced tolerance to treatments and shorter survival. Cancer cachexia may evolve through different stages of clinical relevance, namely pre-cachexia, cachexia and refractory cachexia. Given its detrimental clinical consequences, it appears mandatory to prevent and/or delay the progression of cancer cachexia to its refractory stage by implementing the early recognition and treatment of the nutritional and metabolic alterations occurring during cancer. Research on the molecular mechanisms underlying muscle wasting during cancer cachexia has expanded in the last few years, allowing the identification of several potential therapeutic targets and the development of many promising drugs. Several of these agents have already reached the clinical evaluation, but it is becoming increasingly evident that a single therapy may not be completely successful in the treatment of cancer-related muscle wasting, given its multifactorial and complex pathogenesis. This suggests that early and structured multimodal interventions (including targeted nutritional supplementation, physical exercise and pharmacological interventions) are necessary to prevent and/or treat the devastating consequences of this cancer comorbidity, and future research should focus on this approach.
癌症恶病质是一种严重且使人衰弱的临床病症,常伴随多种癌症的发展。肌肉消耗是癌症恶病质的标志,与身体机能受损、生活质量差、对治疗的耐受性降低以及生存期缩短等严重临床后果相关。癌症恶病质可能会经历不同临床相关阶段,即恶病质前期、恶病质期和难治性恶病质期。鉴于其有害的临床后果,通过对癌症期间发生的营养和代谢改变进行早期识别和治疗,来预防和/或延缓癌症恶病质进展至难治阶段似乎是必要的。在过去几年中,关于癌症恶病质期间肌肉消耗潜在分子机制的研究不断扩展,使得能够确定几个潜在治疗靶点并开发出许多有前景的药物。其中一些药物已经进入临床评估阶段,但鉴于癌症相关肌肉消耗的发病机制具有多因素和复杂性,越来越明显的是单一疗法可能无法完全成功治疗该病。这表明早期且结构化的多模式干预(包括有针对性的营养补充、体育锻炼和药物干预)对于预防和/或治疗这种癌症合并症的毁灭性后果是必要的,未来研究应聚焦于这种方法。