Nutritional support in cancer anorexia-cachexia syndrome

Cancer anorexia-cachexia syndrome (CACS) defi ned by ongoing loss of skeletal muscle mass, with or without loss of fat mass. In contrast to serious non tumorous cachexia it can not be reversed by conventional nutritional support. CACS affects most of cancer patients and has negative impact on physical function, anticancer treatment response, quality of life and survival. It is known that interactions between tumor and reactive host cells are responsible for tumor progression, metastasis formation and chronic infl ammation, as well. All of the processes are induced by cytokines. The CACS associated changes in carbohydrate, protein and lipid metabolism are caused by the elevated level of infl ammatory cytokines. The new anti-CACS drug development aimed at normalizing of the pathologic pathways. Up to now, megestrol-acetate (MA) administration seems to be the most effective drug in CACS treatment. MA has dual effect, stimulates the NPY activation and inhibits the synthesis and expression of infl ammatory cytokines. Its clinical effects are on line with the aboves, improves appetite, calorie intake and increases body weight. There is paradigm shift in CACS treatment, the traditional nutritional support is replaced by combination of pharmaceutical interventions, nutritional support and use of dietary supplements.