Research priorities in cancer cachexia: The University of Rochester Cancer Center NCI Community Oncology Research Program Research Base Symposium on Cancer Cachexia and Sarcopenia

Abstract

Purpose Cancer cachexia remains understudied and there are no standard treatments available despite the publication of an international consensus definition and the completion of several large phase III intervention trials in the past six years. In September 2015, The University of Rochester Cancer Center NCORP Research Base led a Symposium on Cancer Cachexia and Sarcopenia with goals of reviewing the state of the science, identifying knowledge gaps and formulating research priorities in cancer cachexia through active discussion and consensus. Findings Research priorities that emerged from the discussion included the implementation of morphometrics into clinical decision making, establishing specific diagnostic criteria for the stages of cachexia, expanding patient selection in intervention trials, identifying clinically meaningful trial endpoints and the investigation of exercise as an intervention for cancer cachexia. Summary Standardizing how we define and measure cancer cachexia, targeting its complex biologic mechanisms, enrolling subjects early in their disease course and evaluating exercise, either alone or in combination, were proposed as initiatives that may ultimately result in the improved design of cancer cachexia therapeutic trials.

Cachexia and Sarcopenia in Older Adults with Cancer: A Comprehensive Review

“…Resistance training and aerobic training have been shown to increase muscle strength and function and represent an attractive treatment strategy for cachexia and sarcopenia [79]. No pharmacologic or nutritional intervention in the field to date has shown results superior to exercise [73].…”

The Role of Systemic Inflammation in Cancer‐Associated Muscle Wasting and Rationale for Exercise as a Therapeutic Intervention

“…In recent years, the study of exercise as a behavioral intervention in oncology and supportive care research is growing [228]. There is a tremendous need for further exploration into exercise as a therapeutic strategy for cancer cachexia [229]. In addition to its many well-described psychological and physical benefits [230], exercise interventions are easily paired with anti-neoplastic therapies and could potentially improve physical performance, a task that has proven difficult with pharmacologic anti-cachexia agents [231, 232].…”

Pharmacological management of cachexia in adult cancer patients: a systematic review of clinical trials

“…A symposium conducted by the University of Rochester Cancer Center Community Oncology Program on Cancer Cachexia and Sarcopenia identified key areas for future research in area of cancer cachexia. These include: incorporating morphometrics into clinical decision making, focusing on identifying and treating patients at precachexia stages, and identifying long term biomarkers that serve as markers of changes from precachexia to cachexia, expand patient selection in cachexia trials, and identifying and incorporating realistic endpoints into clinical trials including patient reported outcomes [ 4 ]. An important development in the research into cancer cachexia was the acceptance of uniform criteria for its clinical diagnosis by Fearon et al in 2011 [ 5 ].…”

“…Future multicenter trials examining various combinations of agents with anamorelin might pave wave for developing an effective gold standard for managing cachexia in cancer patients. Further, solely relying on BMI as an endpoint of cachexia should be limited, as owing to the growing epidemic of obesity, the proportion of patients presenting with severe weight loss and BMI < 20 continue to decline, and hence incorporating changes in muscle mass is crucial to study comprehensive effect of pharmacological agents on cachexia management [ 4 ]. Additionally, more biomarker driven clinical trials are needed in field of cancer cachexia to prospectively track changes in biomarkers associated with changes in body composition or inflammatory markers among cancer patients.…”

“…Among late stage patients, cachexia affects 50–80% patients and is responsible for 20% of cancer related deaths [ 3 ]. Prevalence of cachexia varies across cancer types and ranges from 60% among lung cancer patients, to about 80% among gastrointestinal cancer (pancreas, stomach, colorectal and esophagus) patients [ 4 ]. Clinically, cachexia is defined through a consensus definition of weight loss of ≥5% of body weight in the past 6 months or ≥ 2% loss in patients with body mass index (BMI) of < 20 kg/m 2 [ 5 ].…”