Nutrological and pharmacological approaches to cancer cachexia: a systematic review

Abstract

Introduction: Cancer cachexia (CC) is a multifactorial syndrome that is generally characterized by the continuous loss of skeletal muscle mass with or without fat loss, often accompanied by anorexia, weakness, and fatigue. Cancer cachexia is associated with poor tolerance to antitumor treatments, reduced quality of life, and a negative impact on survival. Unintentional weight loss has been associated with a negative impact on multiple outcomes in cancer patients, including survival and quality of life. Objective: It was to present the main evidence of the nutrological and pharmacological treatment of cancer cachexia through a systematic review. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from October a December 2023 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 127 articles were found. A total of 67 articles were evaluated and 24 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 10 studies with a high risk of bias and 10 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X2=74.5%>50%. Based on the results, symptoms associated with cancer cachexia are thought to be caused by tumor-induced changes in host metabolism that result in systemic inflammation and abnormal neurohormonal responses. The sarcopenia seen in many patients with cancer cachexia is caused, in part, by increased activation of circulating proteolysis-inducing factor (PIF) and skeletal muscle protein breakdown by the ubiquitin-proteasome pathways. The nutritional consequences of cancer treatments must be identified early with screening and assessment of nutritional status. Nutritional intervention includes screening and appropriate nutritional assessment, which should begin early in the disease course to reduce or delay negative effects on therapy and quality of life. Liquid nutritional supplements may be useful to help increase caloric intake. Numerous investigations have reported orexigenic activity associated with progestational agents such as megestrol acetate and medroxyprogesterone. Megestrol acetate has received the most attention in randomized controlled trials of cancer patients. Also noteworthy was the use of corticosteroids and mirtazapine for weight gain and pain control.