Nutritional support in Cancer Anorexia-Cachexia Syndrome: The reality in light of the facts

Cachexia develops in approximately 50% of cancer patients during their disease progression. In the International Consensus of Amsterdam cancer cachexia defined as a multifactorial syndrome characterized by ongoing loss of skeletal muscle mass that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment. The consensus identified three stages of cachexia: precachexia, cachexia, and refractory cachexia. Severity is classified based on degree of depletion of energy stores, body protein mass and rate of ongoing weight loss. Cancer anorexia-cachexia syndrome (CACS) has negative impact on physical function, anticancer treatment response, quality of life and survival. The interactions between tumor and host are responsible not only for tumor progression, but also for chronic inflammation. The CACS associated changes in carbohydrate, protein and lipid metabolism are caused by the elevated level of inflammatory cytokines. In consistency with the multi-factorial pathogenesis of CACS, it is widely recognized that a multimodal treatment approach is necessary. Currently there is no guideline on clinical management of CACS. Although more and more drug targets are proposed based on research in animal models, only few pharmacological treatments have been translated into clinical practice. In this work we summarize the current nutritional and pharmacological approaches to treat CACS, and the results of clinical trials. However, it is undeniable that, there is a paradigm shift in CACS treatment. The traditional nutritional support is replaced by combination of pharmaceutical interventions, nutritional support and use of dietary supplements.