There’s good news and bad news about cachexia (ka-KEX-i-a).
by Zhenya Senyak
The bad news is it looks scary, feels awful and sends life into a weak-kneed tailspin. The good news is recognition of cachexia and evolving natural treatment are changing the therapeutic landscape.
Conventionally cachexia is characterized by muscle wasting, weight loss, extreme fatigue, and increased chance of infection. Internally it feels like your once hot blood has turned to cold dirty dishwater. Officially, cancer cachexia is a a multi-factorial syndrome characterized by ongoing loss of skeletal muscle mass, with or without loss of fat mass that cannot be fully reversed by conventional nutritional support leading to progressive functional impairment.
The Corie Lok article in Nature, “Cachexia the last illness,” highlights, among other issues, the confusion surrounding the origins and nature of cachexia.
“Research … suggests that cachexia is more than a muscle disease. Studies have identified problems in the brain’s regulation of appetite and feeding, and even ways in which the liver might be contributing to the energy imbalance that sees the body burn its own tissue to sustain itself. Others have looked at fat tissue, which can also waste away in cachexia. They showed that inflammation and molecules made by tumors cause white fat cells to turn into brown fat cells, which burn more energy to generate heat…. The question that researchers are now tackling is how tissues and organs — muscle, brain, fat, even bone — are communicating with one another.”
On every list of advancing myelofibrosis signs and symptoms, cachexia is also a common feature of many late stage cancers and chronic diseases and has long been considered an untreatable disorder. Its very nature as a characteristic of end-stage disease — heart failure, kidney, as well as acute leukemia, lymphoma — has contributed to its invisibility as a separate, treatable disease. Docs are hot on the trail of blocking driving mutations and reducing swollen spleens and will get to your evaporating self later. Truth is, cachexia has been largely ignored by oncologists and hematologists alike with only a small minority alert to its impacts and management.
Myeloproliferative neoplasm treatment protocols lagging.
The NCCN Clinical Practice Guidelines in Oncology for Palliative cite an association between cancer-related cachexia and failure of anti-cancer treatment, increased treatment toxicity, delayed treatment initiation, early treatment termination, shorter survival and psychosocial distress.
Have you talked to your hematologist about cachexia? Did he or she listen? Of cancer specialists surveyed more than half placed little or no importance on Patient Reported Outcomes relating to cachexia/anorexia. And yet, in the NCCN survey of oncologists/hematologists, over 39% recommended starting treatment for cachexia with any weight loss associated with a diagnosis of cancer and over 60% would start cachexia treatment of cancer patients with a 5% weight loss.
Cachexia treatment paradigm is changing
Cachexia treatment formerly relied on drugs such as appetite stimulants megestrol acetate and L-carnitine and antinflammatories, all with little success in clinical trial. But no more. Help — scientifically validated, documented, peer-reviewed help — may now be no further than your local organic grocer, Walgreens and the nearest gym.
No this is not a tree-hugging green conspiracy. Now that we understand cachexia is driven by inflammation and metabolic imbalances it has generated drug targets says Stefan Anker….cachexia specialist at the University Medical Center Gottingen in Germany, ‘Now we have quite a number of powerful options to test.”
And while several clinical trials of drugs designed to increase lean body mass in patients have been disappointing, dramatic success has been reported by simple modifications of diet and exercise routines
The Italian study on MF cachexia and nutrition
One of the most compelling studies is the Italian research published last year by Maccio et al., “Surprising results of a supportive integrated therapy in myelofibrosis.”
“We reported on a case of a patient with MF who presented with weight loss and cachexia associated with severe anemia, fatigue, fever, and bone pain. The circulating levels of inflammatory, oxidative stress parameters, hepcidin, and erythropoietin were evaluated and were above normal ranges. The patient was treated with a multitargeted approach specifically developed for cachexia including oral l-carnitine, celecoxib, curcumin, lactoferrin, and subcutaneous recombinant human erythropoietin (EPO)-α.”
Each of those substances — except for human erythropoietin (EPO)-α EPO-a, commonly used in cases of anemia to combat disrupted erythropoiesis and increase hemoglobin values — are available, most without prescription, at local groceries and pharmacies.
RESULTS: “Surprisingly, after one year, cachexia features improved, all MF symptoms were in remission, and inflammatory and oxidative stress parameters, hepcidin, and EPO were reduced.”
RESULTS: “Surprisingly, after 1 y, cachexia features improved, all MF symptoms were in remission, and inflammatory and oxidative stress parameters, hepcidin, and EPO were reduced.”
The benefits of exercise in improving MF cachexia
Another modality of treatment is free of charge: exercise. For years, as reported in the Journal of Cachexia, Sarcopenia and Muscle cachexia specialists have known the value of exercise, even minimal exercise, particularly in the context of a multi-functional program including diet:” It is interesting,” writes one of the authors , Fabio Penna, molecular biologist at the University of Barcelona, ” to speculate that lower than previously recognized volumes of exercise are quite likely to have a measurable and positive impact in neutralizing muscle loss if practiced diligently and started at early stages of the disease, even in clinical cancer populations.”
Note: A Phase 2 clinical trial A Feasibility Study of Multimodal Exercise/Nutrition/Anti-inflammatory Treatment for Cachexia – the Pre-MENAC Study for which results have not yet published results was sponsored by the Norwegian University for Science and Technology, principal investigator Ken Fearon, D PhD, University of Edinburgh.
Nutrition. 2015 Jan;31(1):239-43. doi: 10.1016/j.nut.2014.07.016.
© 2016, MPNforum, All rights reserved under the Creative Commons Attribution non-commercial-no derivs 3.0 unported