The Role of New Agents and Supportive Care in a Multimodal Approach to Cancer Cachexia

Given the multi-faceted nature of cancer cachexia, a combination of pharmacologic and supportive measures such as exercise and nutrition seems intuitive to most clinicians. Clinical trials have also suggested that a multimodal approach to cancer cachexia (CC) is feasible and potentially effective. However, past trials have been limited by medications that were partially effective or had the potential for serious adverse events such as thromboembolism. We review new agents that have demonstrated efficacy in phase II trials or are involved in multi-center phase III studies. The advent of several recent phase II studies indicate that consistently effective, well-tolerated medications may soon be available for CC. These new agents target several mechanisms involved in CC, including food aversion, catabolism, and decreased anabolism. Several multi-center studies are expected to be actively recruiting this year. If these agents prove to be effective, individualized treatment may be possible, guided by individuals' phenotype and/or clinical biomarkers. Future research should also determine whether combination therapy (pharmacologic and/or non-pharmacologic) produces additive or synergistic benefits.