In addition, 24-hour activity was assessed and the experimental mice had increased performance
In addition, 24-hour activity was assessed and the experimental mice had increased performance.cxlv While data remains conflicting in humans, many oncologic nutritionists and practitioners continue to recommend increased protein intake for patients experiencing CIC based on the strong in-vitro data and known muscle synthesis processes. Micronutrients As noted above, current data regarding nutrition support for CIC is conflicting, however targeted nutritional intake with dietary components is a consideration. the available data to support nutrition-oriented interventions in cancer-induced cachexia, including Rabbit Polyclonal to CLCNKA omega-3 fatty acids, amino-acid loading/protein supplementation, parenteral and enteral nutrition support, and food-derived compounds such as curcumin, reservatrol, and pomegranate. Introduction Cancer-induced cachexia (CIC) is experienced by up to 80% of patients with advanced stage cancer, particularly those with gastrointestinal, pancreatic, thoracic and head and neck malignancies.i CIC has been implicated in up to 20% of cancer-related deaths.ii,iii The definition of cachexia appears to be well-defined among the scientific community, however the term is liberally employed in clinical oncology practice. The 2006 Cachexia Consensus Conference, established cachexia as a complex metabolic syndrome associated Afatinib dimaleate with underlying illness and characterized by loss of muscle with or without loss of fat mass.iv Many oncologists confuse cancer-induced cachexia with simple starvation, or physiologic processes such as sarcopenia (age-related loss of muscle mass).v,vi The clinical confusion regarding cachexia is understandable as most oncologists rely heavily on the Afatinib dimaleate patient’s weight as an indicator of the degree of cachexia experienced. Both cachexia and starvation result in weight loss, however cachexia results from an altered metabolic state due to tumor-derived factors, loss of anabolic stimuli, and an increase in catabolic processes. Unlike starvation, where metabolism slows to conserve body mass, current data suggests that CIC cannot be reversed by feeding alone. The clinical picture is further compounded by muscle loss, a physiologic process as one ages, which may result in sarcopenia. The treating physician may see an elderly, frail, sarcopenic patient experiencing a degree of starvation due to the side effects of cancer therapy who is also cachectic secondary to presence of the tumor (Table 1). Table 1 plant. Synthetic THC is known as dronabinol and is Afatinib dimaleate available as a prescription medication as Marinol? which is prescribed for intractable cancer pain. The starting dose is 2.5 mg orally twice daily with titration up to 20 mg per day. THC has been found to influence the endocannibinoid system, a group of neuromodulatory lipids and their receptors, that are involved in pain perception, emesis and reward pathways.lxiii,lxiv Studies have shown that THC can stimulate appetite and promote food intake in healthy volunteers lxv,lxvi and patients with AIDS.lxvii A number of studies have been conducted to evaluate the effects of THC in patients with CIC. A phase III study involving 243 patients with advanced cancer experiencing cancer-related anorexia-cachexia were randomly assigned (2:2:1) to receive cannabis extract (standardized for 2.5 mg THC and 1 mg cannabidiol) or THC (2.5 mg) or placebo orally, twice daily for 6 weeks. Appetite, mood, and quality of life (QOL) were monitored and cannabinoid-related toxicity was assessed. An independent review board recommended that the trial be closed after interim analysis of 156 patients due to insufficient differences in the primary end point: change in appetite from week 0 to week 6 assessed with the visual analog scale. Subsequent intent-to-treat analysis showed no statistically significant differences between the three arms for appetite, cannabinoid-related toxicity or QOL.lxviii A North Central cancer treatment group trial examined 499 patients with advanced cancer and self-reported appetite and weight loss were randomized to receive (1) oral megestrol acetate 800 mg/day liquid suspension plus placebo, (2) oral dronabinol 2.5 mg twice a day plus placebo, or (3) both agents. Megestrol acetate provided superior anorexia palliation and weight gain among advanced cancer patients compared with dronabinol alone. Combination therapy did not appear to confer additional benefit. However, even at low doses (5 mg daily), dronabinol alone improved appetite in almost 50% of patients. Toxicity was comparable between groups.lxix Growth Hormone and Afatinib dimaleate Anabolic Steroids With the.