Cancer cachexia, mechanism and treatment

Table 1 Cancer cachexia

Treatment	Description	Physiologic benefit	Possible mechanism	Ref.
Megestrol acetate	Active progesterone derivative	Improves appetite, caloric intake, nutritional status, quality of life	Unknown; possible neuropeptide Y release	[80-92]
Medroxyprogesterone	Active progesterone derivative	Improves appetite, food intake Weight stabilization	Decreases serotonin, IL-1, IL-6, TNF-α	[93-96]
Ghrelin	Gastric peptide hormone	Improves lean + total body mass, hand grip, cardiac function (CHF cachexia only)	Growth hormone receptor secretagogue	[105]
Delta-9-tetrahydrocannabinol	Cannabinoid	MIXED May improve food intake, weight gain	Possible endorphin receptor activation, Inhibition of prostaglandin, IL-1	[85,106-110]
Melanocortin antagonists	Adrenocorticotropic hormone antagonist	UNTESTED; prevention of anorexia, loss of lean body mass or basal energy (animal only)	Neuropeptide Y alteration or melanocortin-4 receptor antagonism	[112,113]
Thalidomide	Immunomodulatory	Limits weight and lean body mass loss	Decreases TNF-α, pro-inflammatory cytokines, nuclear factor kappa B, cyclooxygenase 2, angiogenesis	[124-126]
Etanercept	Immunomodulatory	Limits fatigue; improves adjuvant therapy adherence	Decreases TNF effect	[127]
Eicosapentaenoic acid/omega-3-fatty acids	Lipid	MIXED; may improve weight, appetite, quality of life	Decreases pro-inflammatory cytokines, proteolysis inducing factor	[129,130,133,137,140-142,146-152]
Rikkun-shito	Herbal Japanese medicine	Improves median survival with gemcitabine (pancreatic cancer); improves anorexia, GI dysmotility, muscle wasting, anxiety	Unknown	[154,155]
Corticosteroids	Immunomodulatory	Improves appetite and quality of life	Various mechanisms	[156,157]
Formoterol	β2-adrenergic agonist	UNTESTED	Protein and muscle degradation antagonism	[170]
Erythropoetin	Glycoprotein hormone	Improves patient’s metabolic and exercise capacity	Decreases production of IL-6	[171-173]
ACE inhibitors	Heart medications	Reduce wasting of muscle mass	Inhibit TNF-α production	[174]
β-blockers	Heart medications	Preserved body weight, and lean and fat mass, and improved the quality of life	Normalized Akt phosphorylation	[175]

IL: Interleukin; TNF: Tumor necrosis factor.