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21/01/2019 10:38 am
Dietary supplements in the treatment of cancer cachexia
| Agent | Mechanism of action | Ref. |
| N3-fatty acids (EPA, DHA, fish oil) | Reduction of pro-inflammatory cytokines and acute-phase-response | [32-36] |
| L-Carnitine | Antioxidant, cofactor of mitochondrial production of Acetyl-coA (ß-oxidation, aminoacid metabolism) | [37-40] |
| Antioxidants (GSH, ALA, NAC, vitamins A/C/E) | Reduction of ROS-formation and oxidative stress | [42-45] |
| Branched-chain-amino acids | Anabolic effects, stimulation of appetite and food intake | [46-49] |
| Lactoferrin | Increase of hemoglobin in anemic patients, iron-metabolism, decrease of inflammatory response | [50] |
Pharmacological treatment approaches for cancer cachexia
| Agent | Mechanism of action | Ref. | |
| Potentially effective therapies | Progesterone | Appetite stimulation through neuropeptide y | [59,61,90-92] |
| (MA, MPA) | down-regulation of pro-inflammatory cytokines | ||
| Corticosteroids | Inhibition of prostaglandin activity, suppression of IL-1 and TNF-α | [62] | |
| Anabolic androgens | Muscle anabolism, up-regulation of protein synthesis, dose-dependent alterations of Akt-phosphorylation, GLUT-4 and ISR-expression | [64,65] | |
| SARMs | Selective modulation of androgen receptors in muscle tissue only | [67-69] | |
| Experimental therapies | NSAIDs | Inhibition of COX-1 and -2 prostaglandin-synthesis, decrease of inflammatory reaction | [71,72] |
| COX-2 selective inhibitors | Inhibition of prostaglandin-synthesis, decrease of inflammatory reaction, additional antineoplastic and anti-angiogenetic effects | [70,73,92] | |
| Thalidomide | Inhibition of TNF-α, and other pro-inflammatory cytokines, NF-κB, inhibition of COX-2 | [74-76] | |
| Anti-TNF mAb | Inhibition of TNF-α | [78,79] | |
| Anti-IL-6 mAb | Inhibition of IL-6 | [85] | |
| ACE-Inhibitors | Inhibition of angiotensin converting enzyme, role in cancer cachexia not yet fully understood | [88,89] | |
| Myostatin-inhibitors/ActIIrb-antagonists | Inhibition of ActIIrb signaling, stimulation of muscle growth and regeneration | [4,66,86,87] | |
| Ghrelin/Ghrelin mimetics | Stimulation of GH-secretion, appetite stimulation though neuropeptide y, decrease of sympathetic nerve activity | [54-57] | |
| Mirtazepin, Olanzapine | Appetite stimulation through serotonergic blockade | [58,59] | |
| Treatments without proven effectiveness | Pentoxifylline | Inhibition of TNF-α | [77] |
| Insulin, IGF-1, GH | Regulation of body composition (fat, glucose and protein metabolism) via PI3K/Akt-, MAPK-pathways | [63,64,95] | |
| Cannaboids (dronabinol) | Appetite stimulation, energy hemostasis | [53] |
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110568/
