Critical Reviews in Oncology/Hematology 88 (2013) 625–636 Clinical evaluation and optimal management of cancer cachexia a,∗ b a Albert Tuca , Paula Jimenez-Fonseca , Pere Gascón a Department of Medical Oncology, Hospital Clinic Barcelona, Barcelona University, Barcelona, Spain b Department of Medical Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain Accepted 18 July 2013 Contents 1. Introduction . 626 2. Definition of CACS and diagnostic criteria . 626 3. Epidemiology of CACS . 626 4. Pathophysiology of CACS [2,18–20] . 626 4.1. Tumour factors . 627 4.2. Humoral factors. 627 5. Diagnosis and assessment of CACS . 628 5.1. Anthropometric values. 628 5.2. Biological values. 628 5.3. Body composition (BC). 628 5.4. Nutritional indices and validated evaluation instruments. 629 6. Psychosocial impact of CACS . 629 7. Treatment of CACS . 629 7.1. Nutritional support . 629 7.2. Pharmacological treatment of CACS . 629 7.3. Progestogens . 630 7.4. Corticosteroids . 631 7.5. Cannabinoids . 631 7.6. Antiserotoninergic agents . 631 7.7. Cytokine inhibitors . 631 7.8. Anabolic steroids . 632 7.9. Prokinetic agents. 632 7.10. Bortezomib . 632 7.11. Combined treatment. 632 7.12. Drugs in preclinical research . 632 8. Conclusion . 632 8.1. Limitations . 633 Funding . 633 Conflict of interest statement . 633 Reviewers . 633 Acknowledgements. 633 References . 633 Biographies. 635 ∗ Corresponding author. Tel.: +34 932275743. E-mail address: [email protected] (A. Tuca). 1040-8428/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.critrevonc.2013.07.015 626 A. Tuca et al. / Critical Reviews in Oncology/Hematology 88 (2013) 625–636 Abstract Cancer anorexia–cachexia syndrome (CACS) is a complex metabolic syndrome, different from malnutrition and sarcopenia, which is very common in cancer patients. Treatment for CACS is based on nutritional support and CACS pathophysiology-modulating drugs. The most commonly used are megestrol acetate (MA) and corticosteroids. The efficacy of MA has been confirmed by multiple clinical trials and meta- analyses. Glucocorticoids are also effective but should only be used for short periods and in selected cases. Future strategies should include intensified research into potentially effective drugs (␻-3 fatty acids, thalidomide, cannabinoids, ghrelin, bortezomib, and COX-2 inhibitors), combined treatment and new drugs (anti-IL-6 monoclonal antibodies, melanocortin, ␤-2 antagonists, and androgen receptor-modulating analogues). We propose a review based on the literature on the pathophysiology of CACS, the diagnostic criteria and treatment, and future strategies. © 2013 Elsevier Ireland Ltd. All rights reserved. Keywords: Cancer; Cachexia; Anorexia; Megestrol acetate; Malnutrition 1. Introduction Table 1 Consensus criteria for the definition of CACS [1,3,4,7–10]. Involuntary weight loss is very common among cancer Complex, multifactorial metabolic syndrome that causes a negative protein and energy balance (increase in catabolic processes) patients, especially in advanced stages of the disease. This Metabolic changes can often be associated with reduced food intake weight loss is associated with poor tolerability of cancer It is a condition always associated with an underlying disease (cancer or treatment and reduced quality of life and survival expecta- other chronic diseases such as chronic obstructive pulmonary disease, tions. The fundamental cause is anorexia–cachexia syndrome heart failure, renal impairment, etc.) (ACS), a condition in which a persistently elevated basal It causes loss of muscle mass It causes weight loss metabolic rate is not compensated for by adequate calo- It may or may not involve loss of fatty mass rie/protein intake, causing a.