Antoun S, Raynard B
Département Ambulatoire, Gustave-Roussy, Université Paris-Saclay, Villejuif, France.
Département Interdisciplinaire de Soins de Support, Gustave Roussy, Université Paris-Saclay, Chevilly-Larue, France.
Ann Oncol. 2018 Feb;29 Suppl 2:ii10-ii17. doi: 10.1093/annonc/mdx809. Epub 2019 Dec 4.
In the field of oncology, it is well recognized that a decrease in mass, density, strength, or function of skeletal muscle is associated to increased treatment toxicities and postoperative complications, as well as poor progression-free survival and overall survival. The ability of amino acids to stimulate protein synthesis in cancer patients is reduced. Considering nutritional intervention, this anabolic resistance could be in a part counteracted by increasing protein or by giving specific amino acids. In particular, Leucine might counteract this anabolic resistance not only by increasing substrate availability, but also by directly modulating the anabolic signal pathway. Few studies showed the possibility of increasing muscle protein synthesis by specific nutriments and/or by increasing amino acids or protein administration. In addition, whereas many studies provide evidence of a benefit of adapted physical activity in advanced cancer patients, it is difficult to specify the most appropriate type of exercise, and the optimum rhythm and intensity. Moreover, the benefits of physical activities and of protein support seem greater when it is started at the precachexia stage rather than at the cachexia stage, and their benefits are limited or nonexistent at the stage of refractory cachexia. Future approaches should integrate the combination of several complementary treatments in order to prevent (or improve) cachexia and/or sarcopenia in cancer patients.
在肿瘤学领域，人们普遍认识到骨骼肌质量、密度、强度或功能的下降与治疗毒性增加、术后并发症以及无进展生存期和总生存期不佳有关。癌症患者中氨基酸刺激蛋白质合成的能力降低。考虑到营养干预，这种合成代谢抵抗可以通过增加蛋白质或给予特定氨基酸在一定程度上得到抵消。特别是，亮氨酸不仅可以通过增加底物可用性，还可以通过直接调节合成代谢信号通路来抵消这种合成代谢抵抗。很少有研究表明通过特定营养素和/或增加氨基酸或蛋白质摄入量来增加肌肉蛋白质合成的可能性。此外，虽然许多研究提供了适应性体育活动对晚期癌症患者有益的证据，但很难确定最合适的运动类型、最佳节奏和强度。而且，体育活动和蛋白质支持的益处似乎在恶病质前期开始时比在恶病质阶段更大，而在难治性恶病质阶段，它们的益处有限或不存在。未来的方法应该整合多种互补治疗的组合，以预防（或改善）癌症患者的恶病质和/或肌肉减少症。
