PDF(Pubmed)
Abstract：
Despite a better understanding of the mechanisms causing cancer cachexia (CC) and development of promising pharmacologic and supportive care interventions, CC persists as an underdiagnosed and undertreated condition. CC contributes to fatigue, poor quality of life, functional impairment, increases treatment related toxicity, and reduces survival. The core elements of CC such as weight loss and poor appetite should be identified early. Currently, addressing contributing conditions (hypothyroidism, hypogonadism, and adrenal insufficiency), managing nutrition impact symptoms leading to decreased oral intake (nausea, constipation, dysgeusia, stomatitis, mucositis, pain, fatigue, depressed mood, or anxiety), and the addition of pharmacologic agents when appropriate (progesterone analog, corticosteroids, and olanzapine) is recommended. In Japan, the clinical practice has changed based on the availability of Anamorelin, a ghrelin receptor agonist that improved lean body mass, weight, and appetite-related quality of life (QoL) compared to a placebo, in phase III trials. Other promising therapeutic agents currently in trials include Espindolol, a non-selective β blocker and a monoclonal antibody to GDF-15. In the future, a single therapeutic agent or perhaps multiple medications targeting the various mechanisms of CC may prove to be an effective strategy. Ideally, these medications should be incorporated into a multimodal interdisciplinary approach that includes exercise and nutrition.
摘要：
尽管对导致癌症恶病质（CC）的机制有了更好的了解，并开发了有希望的药物和支持性护理干预措施，CC仍然是诊断不足和治疗不足的疾病。CC有助于疲劳，生活质量差，功能损害，增加治疗相关的毒性，减少了生存。应该及早发现CC的核心要素，例如体重减轻和食欲差。目前,解决促成的疾病(甲状腺功能减退，性腺功能减退,和肾上腺功能不全)，管理导致口服摄入量减少的营养影响症状(恶心，便秘,熟食症,口腔炎,粘膜炎,疼痛,疲劳,情绪低落,或焦虑)，并在适当时添加药物(孕酮类似物，皮质类固醇,和奥氮平）建议。在日本,临床实践基于Anamorelin的可用性而改变，一种能改善瘦体重的生长素释放肽受体激动剂，体重,与安慰剂相比，与食欲相关的生活质量(QoL)，在III期试验中。目前正在试验的其他有前途的治疗剂包括埃斯平多洛尔，一种非选择性β受体阻滞剂和抗GDF-15的单克隆抗体。在未来,针对CC各种机制的单一治疗剂或多种药物可能被证明是有效的策略。理想情况下,这些药物应纳入多模式跨学科方法,包括运动和营养.
