RECENT IMPLICATIONS OF WEIGHT-LOSS IN LUNG-CANCER MANAGEMENT

Successful lung cancer management has been hindered by the limited eff icacy of dietary and pharmacologic interventions to prevent or reverse cancer-associated weight loss. The addition of total parenteral nutri tion to chemotherapy in early trials was associated with survival detr iment. Dietary counseling and enteral supplement use are common strate gies that, when evaluated in randomized trials, do not improve anthrop ometrics or clinical outcome in lung cancer. Pharmacologic agents incl uding corticosteroids, cyproheptadine, growth hormone, hydrazine sulfa te, dronabinol, and pentoxyphylline also have failed to improve even a nthropometric parameters in this condition. Megestrol acetate use is a ssociated with appetite stimulation and non-fluid weight gain but, whe n evaluated in small cell lung cancer patients receiving defined chemo therapy, failed to improve global quality of life, and survival and wa s associated with toxicity. New strategies for nutrition-based interve ntions in lung cancer cachexia must consider their potential influence on tumor growth as well as on nutritional status. Recent lung cancer prognostic analyses have identified gender differences in outcome and weight loss that suggest potential targets for combined hormonal and n utrition interventions. Emerging information regarding the influence o f specific fatty acids on tumor growth and cachexia development have i dentified additional approaches for future evaluation.