がん悪液質のメカニズムと治療

がん悪液質のメカニズムと治療のレビュー論文を紹介します。

Fearon K, Arends J, Baracos V. Understanding the mechanisms and treatment options in cancer cachexia. Nat Rev Clin Oncol. 2012 Dec 4. doi: 10.1038/nrclinonc.2012.209. [Epub ahead of print]

悪液質の早期治療（＝早期診断）の重要性が指摘されています。その上で、食欲不振（痛み、吐気）に対して、栄養サポート、抗炎症作用のある薬物もしくは栄養素、レジスタンス運動を組み合わせた包括的治療に、新たな治療方法を開発・実践することで、QOLやがん治療耐性の改善を期待できます。

エビデンスは十分とはいえませんが、がん悪液質に対して栄養・薬物・運動（レジスタンス運動だけでなく有酸素運動もよいと思います）を組み合わせた包括的治療は、もはや標準的なパッケージとあります。がん以外の慢性臓器不全も含めた悪液質に対するリハ栄養＋薬物療法の重要性を早く広めたいです。

Abstract

Cancer cachexia is a metabolic syndrome that can be present even in the absence of weight loss ('precachexia'). Cachexia is often compounded by pre-existing muscle loss, and is exacerbated by cancer therapy. Furthermore, cachexia is frequently obscured by obesity, leading to under-diagnosis and excess mortality. Muscle wasting (the signal event in cachexia) is associated not only with reduced quality of life, but also markedly increased toxicity from chemotherapy. Many of the primary events driving cachexia are likely mediated via the central nervous system and include inflammation-related anorexia and hypoanabolism or hypercatabolism. Treatment of cachexia should be initiated early. In addition to active management of secondary causes of anorexia (such as pain and nausea), therapy should target reduced food intake (nutritional support), inflammation-related metabolic change (anti-inflammatory drugs or nutrients) and reduced physical activity (resistance exercise). Advances in the understanding of the molecular biology of the brain, immune system and skeletal muscle have provided novel targets for the treatment of cachexia. The combination of therapies into a standard multimodal package coupled with the development of novel therapeutics promises a new era in supportive oncology whereby quality of life and tolerance to cancer therapy could be improved considerably.