The panel acknowledged that without stronger evidence, no specific pharmacological therapy is currently considered the standard of care. As a result, clinicians may elect to forgo pharmacologic intervention in favor of other treatment strategies.
“Primary practitioners should be aware that [nonpharmacological] strategies are effective to attenuate weight loss,” Dr Del Fabbro said. “Currently, a major barrier is the absence of an FDA approved drug [for the condition]. Once approved, primary practitioners may be more aware of cachexia, and their important role in the use of a multimodal strategy that includes [nonpharmacological] measures.”
Other Clinical Recommendations
Winston Tan, MD, of the department of internal medicine at the Mayo Clinic in Jacksonville, Florida, and fellow coauthor on the guidelines, told Hematology Advisor, “A nutritional consult is essential for patients with cachexia secondary to cancer. It is important to identify the correctable factors, such as medications, organ obstruction, [and] psychogenic factors.”
“Progestational agents and corticosteroids are the best studied agents and we strongly recommend against parenteral nutrition. There is a window of opportunity to look for medications that would work for this condition, and we need to develop [better] novel agents.”
Another guideline coauthor, Eduardo Bruera, MD, of the department of palliative, rehabilitation and integrative Medicine at the University of Texas MD Anderson Cancer Center in Houston, told Hematology Advisor, “The first step is to be vigilant and always ask about recent weight loss. Many patients who appear overweight have already lost considerable body mass and are cachectic.”
“Dietary recommendations should focus on high energy and protein intake, and, occasionally, pharmacological interventions, including corticosteroids or progestational agents, may be needed,” he explained.
Effective management of cancer cachexia can be challenging for busy clinicians. Ultimately, improving survival and patient quality of life remain key goals of therapy.
1. Aoyagi T, Terracina KP, Raza A, Matsubara H, Takabe K. Cancer cachexia, mechanism and treatment. World J Gastrointest Oncol. 2015;7(4):17‐29.
2. Roeland EJ, Bohlke K, Baracos VE, et al. Management of cancer cachexia: ASCO guideline [published online May 20, 2020]. J Clin Oncol. doi:10.1200/JCO.20.00611
This article originally appeared on Hematology Advisor