Managing cancer-related anorexia/cachexia

Cancer-related anorexia/cachexia (CAC) is a complex phenomenon in which met abolic abnormalities, proinflammatory cytokines produced by the host immune system, circulating tumour-derived catabolic factors, decreased food intak e, and probably additional unknown factors, all play different roles. This review examines the mechanisms of CAC and its management. All the pote ntial modalities of intervention from nutritional to pharmacological approa ches are included with a clear distinction between unproven, investigationa l and well established treatments. Among the tatter, the progestogens are c urrently considered the most effective and safest drugs for the management of CAC, Agents currently under investigation for CAC include thalidomide, p entoxifylline and melatonin, which most probably act on cytokine release, a nd clenbuterol, which acts on muscle mass and to antagonise protein wasting . Our personal experience with the synthetic progestogens megestrol and medro xyprogesterone supports their use as first-line agents. In addition, our wo rk on the potential role of antioxidant agents in counteracting the oxidati ve stress, which appears to be involved in CAC, shows them to be promising agents when used in combination chemotherapy regimens either alone or with other 'biologics'. There is an ongoing need for quality of life questionnaires which specifica lly address the most significant symptoms present in patients with CAC.