がん悪液質のNSAID：系統的レビュー

がん悪液質に対するNSAID（非ステロイド性抗炎症薬）の系統的レビュー論文を紹介します。

Solheim TS, Fearon KC, Blum D, Kaasa S. Non-steroidal anti-inflammatory treatment in cancer cachexia: A systematic literature review. Acta Oncol. 2012 Oct 1. [Epub ahead of print]

リサーチクエスチョンは以下の通りです。

P：がん悪液質患者に
I：NSAIDを使用すると
C：NSAIDを使用しない場合と比較して
O：体重と筋肉量が改善する
D：系統的レビュー

結果ですが、13論文中2論文のみ、体重もしくは除脂肪体重の改善・維持を認めました。7論文は比較対照群がありませんでした。サンプルサイズが小さく、方法論的に欠点のある研究が多かったです。そのため、がん悪液質に対するNSAID使用のエビデンスは脆弱という結論です。

がん（以外も含めて）悪液質で治療に難渋する場合には、NSAIDの使用を考慮してもよいかと思います。ただ現時点では、副作用の問題もありますし、悪液質に対してルーチンでNSAIDを使用することは推奨できません。

Abstract

Background. There are no established treatments for cachexia. Recently it has been suggested that the evidence for non-steroidal anti-inflammatory (NSAID) treatment is sufficient to support its regular clinical use. Primary objective in this systematic review was to assess efficacy and safety of NSAID treatment in improving body weight and muscle mass in patients with cancer cachexia. Secondary objectives were to assess whether this treatment could improve other cachexia domains such as anorexia and food intake, catabolic drive and function. Material and methods. A systematic literature review of PubMed, EMBASE and Cochrane Central register of controlled trials database was carried out using both text words and MeSH/EMTREE terms. Results. Thirteen studies were included; all but two trials showed either improvement or stabilization in weight or lean body mass. Seven studies were without a comparator. Studies are generally small and a few are methodologically flawed, often due to multiple outcomes with excess risk of false positives. Conclusion. NSAIDs may improve weight in cancer patients with cachexia, and there is some evidence on effect on physical performance, self-reported quality of life and inflammatory parameters. Evidence is too frail to recommend NSAID for cachexia outside clinical trials. This is supported by the known side effects of NSAIDs, even though the reviewed literature report almost negligible toxicity.