Addressing cancer anorexia-cachexia in older patients: Potential therapeutic strategies and molecular pathways

Theocharis Ispoglou, Deaglan McCullough, Angela Windle, Sherena Nair, Natalie Cox, Helen White, Dermot Burke, Anastasios Kantas, Konstantinos Prokopidis

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)

Abstract

Cancer cachexia (CC) syndrome, a feature of cancer-associated muscle wasting, is particularly pronounced in older patients, and is characterised by decreased energy intake and upregulated skeletal muscle catabolic pathways. To address CC, appetite stimulants, anabolic drugs, cytokine mediators, essential amino acid supplementation, nutritional counselling, cognitive behavioural therapy, and enteral nutrition have been utilised. However, pharmacological treatments that have also shown promising results, such as megestrol acetate, anamorelin, thalidomide, and delta-9-tetrahydrocannabinol, have been associated with gastrointestinal and cardiovascular complications. Emerging evidence on the efficacy of probiotics in modulating gut microbiota also presents a promising adjunct to traditional therapies, potentially enhancing nutritional absorption and systemic inflammation control. Additionally, low-dose olanzapine has demonstrated improved appetite and weight management in older patients undergoing chemotherapy, offering a potential refinement to current therapeutic approaches. This review aims to elucidate the molecular mechanisms underpinning CC, with a particular focus on the role of anorexia in exacerbating muscle wasting, and to propose pharmacological and non-pharmacological strategies to mitigate this syndrome, particularly emphasising the needs of an older demographic. Future research targeting CC should focus on refining appetite-stimulating drugs with fewer side-effects, specifically catering to the needs of older patients, and investigating nutritional factors that can either enhance appetite or minimise suppression of appetite in individuals with CC, especially within this vulnerable group.
Original languageEnglish
Pages (from-to)552-566
Number of pages15
JournalClinical Nutrition
Volume43
Issue number2
Early online date18 Jan 2024
DOIs
Publication statusPublished - 1 Feb 2024

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