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World J Gastroenterol. Jul 28, 2014; 20(28): 9361-9373
Published online Jul 28, 2014. doi: 10.3748/wjg.v20.i28.9361
Cachexia and pancreatic cancer: Are there treatment options?
Tara C Mueller, Marc A Burmeister, Jeannine Bachmann, Marc E Martignoni
Tara C Mueller, Jeannine Bachmann, Marc E Martignoni, Department of Surgery, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
Marc A Burmeister, Braun Melsungen AG/Department of Anesthesiology, University Hospital Hamburg Eppendorf, 20246 Hamburg, Germany
Author contributions: Mueller TC and Burmeister MA contributed equally to this work; They performed the literature search and wrote the manuscript; Trial results and their clinical relevance were discussed with Martignoni ME and Bachmann J; Furthermore, Martignoni ME and Bachmann J revised and edited the manuscript; all authors were involved in conception and design of the manuscript.
Correspondence to: Marc E Martignoni, Professor, Department of Surgery, University Hospital Rechts der Isar, Technichal University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany. martignoni@tum.de
Telephone: +49-89-41405093 Fax: +49-89-41404870
Received: October 29, 2013
Revised: January 14, 2014
Accepted: February 16, 2014
Published online: July 28, 2014
Processing time: 270 Days and 11.7 Hours
Abstract

Cachexia is frequently described in patients with pancreatic ductal adenocarcinoma (PDAC) and is associated with reduced survival and quality of life. Unfortunately, the therapeutic options of this multi-factorial and complex syndrome are limited. This is due to the fact that, despite extensive preclinical and clinical research, the underlying pathological mechanisms leading to PDAC-associated cachexia are still not fully understood. Furthermore, there is still a lack of consensus on the definition of cachexia, which complicates the standardization of diagnosis and treatment as well as the analysis of the current literature. In order to provide an efficient therapy for cachexia, an early and reliable diagnosis and consistent monitoring is required, which can be challenging especially in obese patients. Although many substances have been tested in clinical and preclinical settings, so far none of them have been proven to have a long-term effect in ameliorating cancer-associated cachexia. However, recent studies have demonstrated that multidimensional therapeutic modalities are able to alleviate pancreatic cancer-associated cachexia and ultimately improve patients’ outcome. In this current review, we propose a stepwise and pragmatic approach to facilitate and standardize the treatment of cachexia in pancreatic cancer patients. This strategy consists of nutritional, dietary, pharmacological, physical and psychological methods.

Keywords: Cachexia; Pancreatic neoplasms; Nutritional support; Gastrointestinal neoplasms

Core tip: Cachexia in pancreatic cancer is frequently described and reduces survival and quality of life of the concerned patients. Despite intense pre-clinical and clinical research activities, there are still no pharmaceutical agents with proven effectiveness in the long term. Furthermore, it is evident that only multimodal concepts can improve patients’ outcome. Therefore, the current pharmacological and nutritional therapy options are reviewed and a stepwise and pragmatic approach will be presented to facilitate and standardize the treatment of cachexia in pancreatic cancer patients. This strategy combines nutritional, dietary, pharmacological and as well physical and psychological methods.