How Can Cancer-Related Wasting – Cachexia Be Treated?

Cancer cachexia-anorexia is a syndrome involving multiple factors that cannot be reversed with ordinary nutritional supplements. Some of these factors have not been clarified. Furthermore, because cachexia mostly appears in advanced stages of cancer, effective treatments are difficult to achieve.

There are two main features seen in cancer cachexia: weight loss and inflammation . Cancer patients frequently experience reduced food intake, and this condition is called anorexia . At the same time, fat tissue rapidly decreases. In muscle tissue, protein synthesis decreases and breakdown increases.

Cancer cachexia-anorexia syndrome causes changes in different tissues and organs.

The following drugs are being used and investigated in cancer cachexia treatment.

1. Megestrol Acetate and MPA (Medroxtyprogesterone): An orally administered synthetic form of the female hormone progesterone. Megestrol Acetate has an interesting discovery story. Previously tested as a cancer drug in breast, uterine and prostate cancer, its anticancer activity was found weak, but increased appetite was discovered as a side effect in patients using it. Megestrol Acetate has received American Food and Drug Administration approval, and in 3963 patients across 35 clinical studies its appetite-stimulating and weight gain-promoting effect has been proven. The drug containing this active ingredient is also approved for use in cancer cachexia in our country. It is the most widely used drug worldwide for this condition. MPA, meanwhile, has been found to reduce the amount of cytokines (inflammation-related molecules = IL-1,IL-6 and TNF-alpha) in cancer patients’ blood.
2. Ghrelin: One of the growth hormones functioning in the stomach. It plays a role in regulating food intake and acid secretion. A recent study found that repeated ghrelin administration prevented deterioration of heart structure and function. Another study observed an increase in total body weight in cancer patients receiving synthetic ghrelin orally.
   Another noteworthy point is that appetite-stimulating ghrelin doses need to be very high. Therefore, the safety of using high doses to increase appetite is debated.
3. Cannabionoids: Known as marijuana, this substance activates cannabinoid receptors in cells that inhibit nerve transmission in the brain. Its positive effect in cancer patients and on weight gain has been identified in 2 separate studies. Another study found that it reduced interleukin 2, one of the inflammation-related cytokines.
4. Melanocortin antagonist: Studies in “laboratory animals” found it effective in preventing weight loss and anorexia through basal energy.
5. Thalidomide: It acts as an immune system regulator. Studies have found that it prevents loss of total body weight and lean body weight in cancer patients.
6. Erythropoetin: It controls the production of red blood cells (white blood cells). This hormone has been observed to increase exercise and metabolic capacity in cancer patients.
7. Beta blockers: They play a role in regulating heart rate and force. Studies have found them effective in maintaining body weight and improving quality of life in cancer patients.

It must be emphasized that the process of developing drugs for cancer cachexia-anorexia treatment is ongoing. Nevertheless, some treatments (such as megestrol) are approved for this condition. You can discuss this highly complex condition with your oncologist and, if necessary, obtain support from dietitians specializing in this field.