Vor 5 Jahren dieser Diskussionsfaden - es wird Zeit, das Thema auf aktuellen Stand zu bringen.
Im Jahre 2006 hatte Urologe fs bei Kachexie dieses vorgeschlagen:
Hans(GL) hatte 2009 geschrieben:
Mittlerweile gibts sogar bei Wiki einen ausführlichen und ziemlich aktuellen Artikel zur Tumorkachexie, von dem könnte man ausgehen.
Ich bin daraufhin den Veröffentlichungen von Giovanni Mantovani nachgestiegen, die PubMed-Suche "Mantovani G cancer cachexia" liefert 35 Treffer - ich hätte auch nach Fearon K aus Glasgow suchen können, das Team dort ist auch schon länger am Thema dran.
Unten die beiden Abstracte:
a) ganz aktuell aus Lancet eine Konsens-Definition;
b) die schon 2009 von Mantovani getroffene Feststellung, dass man therapeutisch nicht erhoffen kann, dass einzelne Stoffe irgendwas bringen - nur die Kombi, wenn überhaupt (da die zugrundeliegende Krebserkrankung nicht weg ist)
Ansonsten hier im fulltext eine Phase-III-Studie von Mantovani et al., die folgende Kombi-Therapie als geeignet herausgefunden hat:
EPA, Thalidomid, Carnitin - das kennen wir.
Megestrol ist ein Appetitanreger (wie Cannabinoide auch)
Und wie das Progesteron gedacht ist, muss ich erst noch lesen ...
Und der EPA-story möchte ich erneut hinterherlesen, denn damals hatte ich eigentlich davon mehr erwartet, aber das wird Mr.Fearon aus Glasgow näher wissen. Mein Eindruck damals war, dass die Dosis nicht stimmte. Auch jetzt erscheinen mit die 2,2 g EPA pro Tag, die in der Phase-III-Studie gegeben wurden, viel zu wenig.
Übrigens bekamen alle Patienten auch noch als Basis-Versorgung dieses:
Wenn man sich jetzt vorstellt, da wäre statt oder zusätzlich zur oralen Gabe auch noch eine Infusions-Praxis gemacht worden ...
Rudolf
+++++++++++++++++++++++++++++++++++++++++++
Lancet Oncol. 2011 May;12(5):489-95. Epub 2011 Feb 4.
Definition and classification of cancer cachexia: an international consensus.
Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, Macdonald N, Mantovani G, Davis M, Muscaritoli M, Ottery F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Baracos VE.
Source
Clinical and Surgical Sciences, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, UK.
Abstract
To develop a framework for the definition and classification of cancer cachexia a panel of experts participated in a formal consensus process, including focus groups and two Delphi rounds. Cancer cachexia was defined as a multifactorial syndrome defined by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment. Its pathophysiology is characterised by a negative protein and energy balance driven by a variable combination of reduced food intake and abnormal metabolism. The agreed diagnostic criterion for cachexia was weight loss greater than 5%, or weight loss greater than 2% in individuals already showing depletion according to current bodyweight and height (body-mass index [BMI] <20 kg/m(2)) or skeletal muscle mass (sarcopenia). An agreement was made that the cachexia syndrome can develop progressively through various stages-precachexia to cachexia to refractory cachexia. Severity can be classified according to degree of depletion of energy stores and body protein (BMI) in combination with degree of ongoing weight loss. Assessment for classification and clinical management should include the following domains: anorexia or reduced food intake, catabolic drive, muscle mass and strength, functional and psychosocial impairment. Consensus exists on a framework for the definition and classification of cancer cachexia. After validation, this should aid clinical trial design, development of practice guidelines, and, eventually, routine clinical management.
Copyright © 2011 Elsevier Ltd. All rights reserved.
PMID: 21296615 [PubMed - in process]
+++++++++++++++++++++++++++++++++++++++++++
Support Care Cancer. 2009 Aug 18. [Epub ahead of print]
Cancer cachexia: medical management.
Mantovani G, Madeddu C.
Source
Department of Medical Oncology, University of Cagliari, Cagliari, Italy, mantovan@medicina.unica.it.
Abstract
BACKGROUND:
Cachexia is a complex metabolic syndrome associated with many chronic or end-stage diseases, especially cancer, and is characterized by loss of muscle with or without loss of fat mass. The management of cachexia is a complex challenge that should address the different causes underlying this clinical event with an integrated or multimodal treatment approach targeting the different factors involved in its pathophysiology.
MATERIALS AND METHODS:
The purpose of this article was to review the current medical treatment of cancer-related cachexia, in particular focusing on combination therapy and ongoing research.
RESULTS:
Among the treatments proposed in the literature for cancer-related cachexia, some proved to be ineffective, namely, cyproheptadine, hydrazine, metoclopramide, and pentoxifylline. Among effective treatments, progestagens are currently considered the best available treatment option for cancer-related cachexia, and they are the only drugs approved in Europe. Drugs with a strong rationale that have failed or have not shown univocal results in clinical trials so far include eicosapentaenoic acid, cannabinoids, bortezomib, and anti-TNF-alpha MoAb. Several emerging drugs have shown promising results but are still under clinical investigation (thalidomide, selective cox-2 inhibitors, ghrelin mimetics, insulin, oxandrolone, and olanzapine).
CONCLUSIONS:
To date, despite several years of co-ordinated efforts in basic and clinical research, practice guidelines for the prevention and treatment of cancer-related muscle wasting are lacking, mainly because of the multifactorial pathogenesis of the syndrome. From all the data presented, one can speculate that one single therapy may not be completely successful in the treatment of cachexia. From this point of view, treatments involving different combinations are more likely to be successful.
PMID: 19688225 [PubMed - as supplied by publisher]
Im Jahre 2006 hatte Urologe fs bei Kachexie dieses vorgeschlagen:
Hallo,
drei Ansätze bei Kachexie:
- Erypo gegen die Anaemie
- Drocannabinol gegen Appetitlosigkeit und Untergewicht
- Testosterongabe
Gruss
fs
drei Ansätze bei Kachexie:
- Erypo gegen die Anaemie
- Drocannabinol gegen Appetitlosigkeit und Untergewicht
- Testosterongabe
Gruss
fs
Meine Auszehrung und Kachexie wurde durch Vitamine, Omega 3, Aminosäuren, Spurenelemente und Cortison gestoppt. Ich nehme wieder an Gewicht zu.
Hans
Hans
Ich bin daraufhin den Veröffentlichungen von Giovanni Mantovani nachgestiegen, die PubMed-Suche "Mantovani G cancer cachexia" liefert 35 Treffer - ich hätte auch nach Fearon K aus Glasgow suchen können, das Team dort ist auch schon länger am Thema dran.
Unten die beiden Abstracte:
a) ganz aktuell aus Lancet eine Konsens-Definition;
b) die schon 2009 von Mantovani getroffene Feststellung, dass man therapeutisch nicht erhoffen kann, dass einzelne Stoffe irgendwas bringen - nur die Kombi, wenn überhaupt (da die zugrundeliegende Krebserkrankung nicht weg ist)
Ansonsten hier im fulltext eine Phase-III-Studie von Mantovani et al., die folgende Kombi-Therapie als geeignet herausgefunden hat:
medroxyprogesterone (500 mg/day);
megestrol acetate (320 mg/day);
oral supplementation with eicosapentaenoic acid;
L-carnitine (4 g/day);
thalidomide (200 mg/day);
megestrol acetate (320 mg/day);
oral supplementation with eicosapentaenoic acid;
L-carnitine (4 g/day);
thalidomide (200 mg/day);
Megestrol ist ein Appetitanreger (wie Cannabinoide auch)
Und wie das Progesteron gedacht ist, muss ich erst noch lesen ...
Und der EPA-story möchte ich erneut hinterherlesen, denn damals hatte ich eigentlich davon mehr erwartet, aber das wird Mr.Fearon aus Glasgow näher wissen. Mein Eindruck damals war, dass die Dosis nicht stimmte. Auch jetzt erscheinen mit die 2,2 g EPA pro Tag, die in der Phase-III-Studie gegeben wurden, viel zu wenig.
Übrigens bekamen alle Patienten auch noch als Basis-Versorgung dieses:
All patients included in the study were given, as basic treatment, polyphenols (300 mg/days) obtained by dietary sources or supplemented with tablets (Nova-Q; Pharma
Gam, Cagliari, Italy), lipoic acid (300 mg/day, present in Nova-Q tablets), carbocysteine (Fluifort; Dompe´, Milan, Italy) (2.7 g/day), vitamin E (400 mg/day), vitamin A (30,000 IU/day), and vitamin C (500 mg/day), all orally.
Gam, Cagliari, Italy), lipoic acid (300 mg/day, present in Nova-Q tablets), carbocysteine (Fluifort; Dompe´, Milan, Italy) (2.7 g/day), vitamin E (400 mg/day), vitamin A (30,000 IU/day), and vitamin C (500 mg/day), all orally.
Rudolf
+++++++++++++++++++++++++++++++++++++++++++
Lancet Oncol. 2011 May;12(5):489-95. Epub 2011 Feb 4.
Definition and classification of cancer cachexia: an international consensus.
Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, Macdonald N, Mantovani G, Davis M, Muscaritoli M, Ottery F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Baracos VE.
Source
Clinical and Surgical Sciences, School of Clinical Sciences and Community Health, University of Edinburgh, Royal Infirmary, Edinburgh, UK.
Abstract
To develop a framework for the definition and classification of cancer cachexia a panel of experts participated in a formal consensus process, including focus groups and two Delphi rounds. Cancer cachexia was defined as a multifactorial syndrome defined by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment. Its pathophysiology is characterised by a negative protein and energy balance driven by a variable combination of reduced food intake and abnormal metabolism. The agreed diagnostic criterion for cachexia was weight loss greater than 5%, or weight loss greater than 2% in individuals already showing depletion according to current bodyweight and height (body-mass index [BMI] <20 kg/m(2)) or skeletal muscle mass (sarcopenia). An agreement was made that the cachexia syndrome can develop progressively through various stages-precachexia to cachexia to refractory cachexia. Severity can be classified according to degree of depletion of energy stores and body protein (BMI) in combination with degree of ongoing weight loss. Assessment for classification and clinical management should include the following domains: anorexia or reduced food intake, catabolic drive, muscle mass and strength, functional and psychosocial impairment. Consensus exists on a framework for the definition and classification of cancer cachexia. After validation, this should aid clinical trial design, development of practice guidelines, and, eventually, routine clinical management.
Copyright © 2011 Elsevier Ltd. All rights reserved.
PMID: 21296615 [PubMed - in process]
+++++++++++++++++++++++++++++++++++++++++++
Support Care Cancer. 2009 Aug 18. [Epub ahead of print]
Cancer cachexia: medical management.
Mantovani G, Madeddu C.
Source
Department of Medical Oncology, University of Cagliari, Cagliari, Italy, mantovan@medicina.unica.it.
Abstract
BACKGROUND:
Cachexia is a complex metabolic syndrome associated with many chronic or end-stage diseases, especially cancer, and is characterized by loss of muscle with or without loss of fat mass. The management of cachexia is a complex challenge that should address the different causes underlying this clinical event with an integrated or multimodal treatment approach targeting the different factors involved in its pathophysiology.
MATERIALS AND METHODS:
The purpose of this article was to review the current medical treatment of cancer-related cachexia, in particular focusing on combination therapy and ongoing research.
RESULTS:
Among the treatments proposed in the literature for cancer-related cachexia, some proved to be ineffective, namely, cyproheptadine, hydrazine, metoclopramide, and pentoxifylline. Among effective treatments, progestagens are currently considered the best available treatment option for cancer-related cachexia, and they are the only drugs approved in Europe. Drugs with a strong rationale that have failed or have not shown univocal results in clinical trials so far include eicosapentaenoic acid, cannabinoids, bortezomib, and anti-TNF-alpha MoAb. Several emerging drugs have shown promising results but are still under clinical investigation (thalidomide, selective cox-2 inhibitors, ghrelin mimetics, insulin, oxandrolone, and olanzapine).
CONCLUSIONS:
To date, despite several years of co-ordinated efforts in basic and clinical research, practice guidelines for the prevention and treatment of cancer-related muscle wasting are lacking, mainly because of the multifactorial pathogenesis of the syndrome. From all the data presented, one can speculate that one single therapy may not be completely successful in the treatment of cachexia. From this point of view, treatments involving different combinations are more likely to be successful.
PMID: 19688225 [PubMed - as supplied by publisher]
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