がん悪液質の多方面からの治療

がん悪液質の多方面からの治療に関するレビュー論文を紹介します。

Madeddu C, Maccio A, Mantovani G. Multitargeted treatment of cancer cachexia. Crit Rev Oncog. 2012;17(3):305-14.

薬物治療としては、サリドマイド、選択的COX-2阻害剤、グレリン模倣剤、選択的アンドロゲン受容体調節剤が期待されますが、さらなる研究が必要です。栄養療法、タンパク同化剤、抗炎症剤、適切な運動療法を併用した多方面からの治療の臨床研究が望まれます。

包括的治療の中に栄養療法と運動療法が含まれています。つまり、悪液質に対しては適切なリハ栄養が重要ともいえます。画期的な薬剤が開発されれば、栄養と運動のウエイトは低下すると思いますが、それは当分先の話だと思われます。現状ではがん悪液質に対して適切なリハ栄養を実施できる体制を作りたいですね。

Abstract

Cancer cachexia is defined as a multifactorial syndrome characterized 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. The prominent clinical feature of cachexia is weight loss in adults. Anorexia, inflammation, insulin resistance, and increased muscle protein breakdown frequently are associated with cachexia. One single therapy may not be completely successful in the treatment of cachexia because of the complexity of the pathogenesis and symptoms of the cachexia syndrome. Among effective treatments, progestogens currently are considered the best available treatment option and are the only approved drugs in Europe for the treatment of cancer- and AIDS-related cachexia. However, they have limited efficacy in treating cancer cachexia. However, thalidomide, selective COX-2 inhibitors, ghrelin mimetics, and selective androgen receptor modulators showed promising results but should be defined further and confirmed in clinical trials. Therefore, to date, despite several years of coordinated efforts in basic and clinical research, the practice guidelines for the prevention and treatment of cancer-related anorexia cachexia syndrome (CACS) are lacking. The management of CACS is a complex challenge that should address the different causes underlying this clinical event. Recent studies showed that integrated, multitargeted approaches are more effective than single-agent approaches for the treatment of CACS. Further clinical trials to improve and refine current strategies to counteract cancer cachexia using multimodal interventions, including nutritional supplementation, anabolic agents, and antiinflammatory drugs along with an appropriate physical exercise program, are warranted.