Cachexia

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March 5, 2013 at 2:47 am  #1254484    

theadvocate

Dr. West,

My grandfather was diagnosed with metastatic squamuos LC with right hilar mass, L1 (resected/corpectomy) and bony pelvis. My concern, other than the disease itself, is cachexia. I cannot delineate whether or not the PT definitely suffers from cachexia, but I do know he has lost at least 25 lbs over the last year or more – not sure if within a 6 month period but most likely.

Are there any biological treatments that have proven to be effective in reducing the effects of cachexia (other than omega\’s anti-inflammatory supplementation)? The patient has Type II; although insulin is not required as of yet (except for when he was on dexamethasone while admitted), graves disease, and iron deficient anemia. I would think from a fundamental standpoint testosterone could be beneficial to some extent, especially in an elderly patient. I am also going to assume that there are no ActRIIB trials online yet. I am aware of Acceleron’s muscle dystrophy which was discontinued due to bleeding issues.

Dr. Konstantin Salnikow, of NCI, states “targeting cachexia could have a spillover effect on the tumor, perhaps robbing cancer cells of molecules they use for energy that are produced by the excess breakdown of muscle. He has other hopes as well.”

That leads me to ask: Do we know if the “intensity” of cachexia is directly correlated with the AMOUNT of physical disease in the body? Meaning the more mass, the more likely cachexia will rear its head. I ask because I am curious if there are any benefits of radiating the lung mass prior to chemo other than for palliative purposes. We know that the acceptable way to treat systemic disease is by chemo, but would there be any direct benefit to reducing the effects of cachexia through RT by reducing the amount of physical disease?

Also, is there a specific albumin figure that indicates cachexia? PT was at 3.8 prior to surgery then dipped and stayed at around 2.8 since. Need recent testing.

Eternal thanks.

March 5, 2013 at 7:40 am  #1254486    

Dr West

I’m sorry your father is dealing with this. Here’s a post that really describes what we know and what we can do:

http://cancergrace.org/cancer-treatments/2009/02/16/acs-mgmt/

There’s not, to my knowledge, an albumin cut-off level. I would say that cachexia is a somewhat relative, subjective complication, like hair loss.

There is also no evidence that the probability of developing cached is is related to “tumor burden”, so that radiating an area in the setting of metastatic disease would be expected to improve cachexia.

There are some treatments that are the subject of some late-stage clinical research to help build up muscle mass and functional status, but we haven’t seen the outcomes of this research yet.

Good luck

-Dr. West


Howard (Jack) West, MD
Medical Oncologist

Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

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