Addressing cancer anorexia-cachexia in older patients: potential therapeutic strategies and molecular pathways
Addressing cancer anorexia-cachexia in older patients: potential therapeutic strategies and molecular pathways
Cancer cachexia (CC) syndrome, a feature of cancer-associated muscle wasting, is particularly pronounced in older patients, and is characterised by decreased energy intake and upregulated skeletal muscle catabolic pathways. To address CC, appetite stimulants, anabolic drugs, cytokine mediators, essential amino acid supplementation, nutritional counselling, cognitive behavioural therapy, and enteral nutrition have been utilised. However, pharmacological treatments that have also shown promising results, such as megestrol acetate, anamorelin, thalidomide, and delta-9-tetrahydrocannabinol, have been associated with gastrointestinal and cardiovascular complications. Emerging evidence on the efficacy of probiotics in modulating gut microbiota also presents a promising adjunct to traditional therapies, potentially enhancing nutritional absorption and systemic inflammation control. Additionally, low-dose olanzapine has demonstrated improved appetite and weight management in older patients undergoing chemotherapy, offering a potential refinement to current therapeutic approaches. This review aims to elucidate the molecular mechanisms underpinning CC, with a particular focus on the role of anorexia in exacerbating muscle wasting, and to propose pharmacological and non-pharmacological strategies to mitigate this syndrome, particularly emphasising the needs of an older demographic. Future research targeting CC should focus on refining appetite-stimulating drugs with fewer side-effects, specifically catering to the needs of older patients, and investigating nutritional factors that can either enhance appetite or minimise suppression of appetite in individuals with CC, especially within this vulnerable group.
cancer cachexia; anorexia; muscle wasting; sarcopenia; nutrition; drugs
552-566
Ispoglou, Theocharis
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McCullough, Deaglan
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Windle, Angela
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Nair, Sherena
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Cox, Natalie
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White, Helen
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Burke, Dermot
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Kanatas, Anastasios
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Prokopidis, Konstantinos
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Ispoglou, Theocharis
20dccf71-a45f-4af9-bd3b-30ebef71a92e
McCullough, Deaglan
4a615751-ad7a-47c0-a9c2-51591d9088e6
Windle, Angela
1d371b3f-a9ec-48bd-ba6f-36ba238c7464
Nair, Sherena
b9217152-cb11-410e-a4bb-8bdbea78e034
Cox, Natalie
dfdfbc5f-41b8-4329-a4b5-87b6e93aa09e
White, Helen
637a780e-a8e3-4a8f-a31f-9118fa875381
Burke, Dermot
24a56de0-a963-409b-82f2-60d2a1046cf5
Kanatas, Anastasios
a92308bd-c527-4040-aa43-464e83eaf352
Prokopidis, Konstantinos
31f1f079-d93c-4ecd-9de6-df7759180fd8
Ispoglou, Theocharis, McCullough, Deaglan, Windle, Angela, Nair, Sherena, Cox, Natalie, White, Helen, Burke, Dermot, Kanatas, Anastasios and Prokopidis, Konstantinos
(2024)
Addressing cancer anorexia-cachexia in older patients: potential therapeutic strategies and molecular pathways.
Clinical Nutrition, 43 (2), .
(doi:10.1016/j.clnu.2024.01.009).
Abstract
Cancer cachexia (CC) syndrome, a feature of cancer-associated muscle wasting, is particularly pronounced in older patients, and is characterised by decreased energy intake and upregulated skeletal muscle catabolic pathways. To address CC, appetite stimulants, anabolic drugs, cytokine mediators, essential amino acid supplementation, nutritional counselling, cognitive behavioural therapy, and enteral nutrition have been utilised. However, pharmacological treatments that have also shown promising results, such as megestrol acetate, anamorelin, thalidomide, and delta-9-tetrahydrocannabinol, have been associated with gastrointestinal and cardiovascular complications. Emerging evidence on the efficacy of probiotics in modulating gut microbiota also presents a promising adjunct to traditional therapies, potentially enhancing nutritional absorption and systemic inflammation control. Additionally, low-dose olanzapine has demonstrated improved appetite and weight management in older patients undergoing chemotherapy, offering a potential refinement to current therapeutic approaches. This review aims to elucidate the molecular mechanisms underpinning CC, with a particular focus on the role of anorexia in exacerbating muscle wasting, and to propose pharmacological and non-pharmacological strategies to mitigate this syndrome, particularly emphasising the needs of an older demographic. Future research targeting CC should focus on refining appetite-stimulating drugs with fewer side-effects, specifically catering to the needs of older patients, and investigating nutritional factors that can either enhance appetite or minimise suppression of appetite in individuals with CC, especially within this vulnerable group.
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Accepted/In Press date: 10 January 2024
e-pub ahead of print date: 12 January 2024
Keywords:
cancer cachexia; anorexia; muscle wasting; sarcopenia; nutrition; drugs
Identifiers
Local EPrints ID: 486304
URI: http://eprints.soton.ac.uk/id/eprint/486304
ISSN: 0261-5614
PURE UUID: 767c744a-9756-48b2-9634-18e18c9e3525
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Date deposited: 17 Jan 2024 17:31
Last modified: 24 Apr 2024 02:10
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Contributors
Author:
Theocharis Ispoglou
Author:
Deaglan McCullough
Author:
Angela Windle
Author:
Sherena Nair
Author:
Natalie Cox
Author:
Helen White
Author:
Dermot Burke
Author:
Anastasios Kanatas
Author:
Konstantinos Prokopidis
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