Davis Mellar P, Panikkar Rajiv
Department of Palliative Care, Geisinger Medical Center, Danville, PA, USA.
Cancer Center, Geisinger Medical Center, Danville, PA, USA.
Ann Palliat Med. 2019 Jan;8(1):86-101. doi: 10.21037/apm.2018.08.02. Epub 2018 Sep 7.
Clinicians often believe that cachexia is caused by cancer and anorexia as a toxicity of chemotherapy or targeted anti-cancer agents. It is now recognized that chemotherapy and certain targeted agents cause sarcopenia which reduce physical function and quality of life. Pre-treatment sarcopenia predicts chemotherapy toxicity, reduced response, increased disability, poor anti-tumor response and survival. Though bioelectrical impedance and dual energy X-ray absorptiometry (DEXA) scans have been used in the past for body composition measurements, CT scan cuts at the level of the 3rd lumbar vertebral body with measurement of skeletal muscle and visceral and subcutaneous fat areas has become standard. Nonpharmacological approaches to reducing sarcopenia during chemotherapy includes resistance training and dietary counselling. Pharmacologic therapies include vitamin D replacement if depleted, omega-3 fatty acids, testosterone and selective androgen receptor modulators (SARMS) and ghrelin. A comprehensive multimodal and multiple drug approach is likely to be better than single modalities. However, this is yet to be proven. Finally, it is not known if intervening to prevent or reverse sarcopenia will have a clinical benefit in terms of better tolerance to cancer therapy, physical function, well-being, tumor response and survival. Reversing sarcopenia and improving objective outcomes should be the goal of therapy.
临床医生通常认为恶病质是由癌症以及化疗或靶向抗癌药物的毒性导致的厌食所引起的。现在人们认识到，化疗和某些靶向药物会导致肌肉减少症，从而降低身体功能和生活质量。治疗前的肌肉减少症可预测化疗毒性、反应降低、残疾增加、抗肿瘤反应不佳以及生存率降低。尽管过去曾使用生物电阻抗和双能X线吸收法（DEXA）扫描来测量身体成分，但在第三腰椎椎体水平进行CT扫描并测量骨骼肌、内脏和皮下脂肪面积已成为标准方法。化疗期间减少肌肉减少症的非药物方法包括阻力训练和饮食咨询。药物治疗包括在维生素D缺乏时进行补充、使用ω-3脂肪酸、睾酮、选择性雄激素受体调节剂（SARMs）和胃饥饿素。综合的多模式和多种药物方法可能比单一模式更好。然而，这一点尚未得到证实。最后，尚不清楚干预预防或逆转肌肉减少症是否会在对癌症治疗的更好耐受性、身体功能、幸福感、肿瘤反应和生存率方面带来临床益处。逆转肌肉减少症并改善客观结果应成为治疗的目标。
