The cancer-related anorexia/cachexia syndrome (CACS) is a complex phenomen characterized by symptoms such as anorexia, weight loss (accompanied by a decrease in muscle mass and adipose tissue), increased resting energy expenditure (associated to several abnormalities of glucose, lipid and protein metabolism), nausea and/or vomiting, immunodepression, reduced efficacy and increased side effects of antineoplastic agents. Anorexia cannot by itself account for all the complex organic changes seen in CACS. In addition to the reduced food intake, several factors contribute to the pathogenesis of CACS: abnormalities of the energy metabolism, proinflammatory cytokines produced by the immune system and by the tumor itself, circulating tumor-derived catabolic factors, and probably additional unknown factors. Numerous experimental and clinical studies showed that some proinflammatory cytokines, that play a central role in the chronic activation of the immune system associated to tumor progression, may induce the metabolic alterations of CACS. Recent reports have addressed the question of the hypothetic role of leptin on the pathogenesis of CACS: these studies demonstrated that advanced cancer patients have low leptin levels, suggesting that leptin cannot be considered the cause of weight loss in cancer. This article examines the mechanisms underlying CACS and its treatment. Among the drugs used in the management of CACS the progestogens are currently considered the most effective ones. Agents currently under investigation include nonsteroidal anti-inflammatory drugs, melatonin, omega-3 fatty acids, β2 agonists, antioxidant agents. Our experimental and clinical experience with synthetic progestogens, megestrol and medroxyprogesterone acetate, supports their use as first-line agents. In addition, our recent works on the potential role of antioxidants in counteracting the oxidative stress, which appears to be involved in CACS, show them to be promising agents especially when used in combination with other "biologics".

Role of proinflammatory cytokines and leptin in cancer-related anorexia/cachexia. Metabolic abnormalities and therapeutic approaches = Ruolo delle citochine infiammatorie e della leptina nell'anoressia/cachessia neoplastica. Aspetti metabolici e terapeutici

Mantovani G;Macciò A;MADEDDU, CLELIA;Massa E
Investigation
;
2002-01-01

Abstract

The cancer-related anorexia/cachexia syndrome (CACS) is a complex phenomen characterized by symptoms such as anorexia, weight loss (accompanied by a decrease in muscle mass and adipose tissue), increased resting energy expenditure (associated to several abnormalities of glucose, lipid and protein metabolism), nausea and/or vomiting, immunodepression, reduced efficacy and increased side effects of antineoplastic agents. Anorexia cannot by itself account for all the complex organic changes seen in CACS. In addition to the reduced food intake, several factors contribute to the pathogenesis of CACS: abnormalities of the energy metabolism, proinflammatory cytokines produced by the immune system and by the tumor itself, circulating tumor-derived catabolic factors, and probably additional unknown factors. Numerous experimental and clinical studies showed that some proinflammatory cytokines, that play a central role in the chronic activation of the immune system associated to tumor progression, may induce the metabolic alterations of CACS. Recent reports have addressed the question of the hypothetic role of leptin on the pathogenesis of CACS: these studies demonstrated that advanced cancer patients have low leptin levels, suggesting that leptin cannot be considered the cause of weight loss in cancer. This article examines the mechanisms underlying CACS and its treatment. Among the drugs used in the management of CACS the progestogens are currently considered the most effective ones. Agents currently under investigation include nonsteroidal anti-inflammatory drugs, melatonin, omega-3 fatty acids, β2 agonists, antioxidant agents. Our experimental and clinical experience with synthetic progestogens, megestrol and medroxyprogesterone acetate, supports their use as first-line agents. In addition, our recent works on the potential role of antioxidants in counteracting the oxidative stress, which appears to be involved in CACS, show them to be promising agents especially when used in combination with other "biologics".
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11584/46928
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