General Metabolic Abnormalities in Cancer Patients: Anorexia and Cachexia

Holroyde, Christopher P.; Reichard, George A.

doi:10.1016/s0039-6109(16)44034-x

Cited by 39 publications

(12 citation statements)

References 34 publications

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“…Several processes control plasma albumin concentration, including absolute rate of albumin synthesis and fractional catabolic rate (FCR), among others. It has been previously demonstrated that patients with advanced cancer have an important energy expenditure caused by increased tumor metabolism [41] and specifically in patients with NSCLC, also by means of chronic airway limitation [42] Therefore, serum albumin levels can be modified by tumor activity via increased FCR, but also by decreasing albumin synthesis, given that the majority of the time, patients with NSCLC display decreased appetite [43] and diminish their food intake [44]. …”

Section: Discussionmentioning

confidence: 99%

Association of nutritional status and serum albumin levels with development of toxicity in patients with advanced non-small cell lung cancer treated with paclitaxel-cisplatin chemotherapy: a prospective study

et al. 2010

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BackgroundA frequent manifestation of advanced NSCLC is malnutrition, even though there are many studies which relate it with a poor survival, its relation with toxicity has not yet been consistently reported. The aim of this study was to associate malnutrition and albumin serum levels with the occurrence of chemotherapy-induced toxicity in cisplatin plus paclitaxel chemotherapy-treated NSCLC.MethodsWe prospectively evaluated 100 stage IV NSCLC patients treated with paclitaxel (175 mg/m2) and cisplatin (80 mg/m2). Malnutrition was assessed using SGA prior treatment. Neutrophil Lymphocyte Ratio (NLR) and the Platelet Lymphocyte Ratio (PLR) were used to determine the presence of systemic inflammatory response (SIR) and were related to the development of toxicity. Toxicity was graded according to NCI CTCAE version 3.0 after two chemotherapy cycles.ResultsMedian age was 58 ± 10 years, 51% of patients were malnourished, 50% had albumin ≤3.0 mg/mL. NLR ≥ 5 was associated with basal hypoalbuminemia (mean ranks, 55.7 vs. 39 p = 0.006), ECOG = 2 (47.2 vs. 55.4 p = 0.026) and PLR ≥ 150 were significantly related with a basal body mass index ≤20 (56.6 vs. 43.5; p = 0.02) and hypoalbuminemia (58.9 vs. 41.3; p = 0.02). Main toxicities observed after 2 cycles of chemotherapy were alopecia (84%), nausea (49%), neuropathy (46%), anemia (33%), lymphopenia (31%), and leukopenia (30%). Patients malnourished and with hypoalbuminemia developed more chemotherapy-induced toxicity overall when compared with those without malnutrition (31 vs 22; p = 0.02) and normal albumin (mean ranks, 62 vs 43; p = 0.002), respectively. Hypoalbuminemia was associated with anemia (56 vs 47; p = 0.05), fatigue (58 vs 46; p = 0.01), and appetite loss (57.1 vs 46.7; p = 0.004) compared with normal albumin. PLR ≥ 150 was related with the development of toxicity grade III/IV (59.27 vs. 47.03 p = 0.008) and anemia (37.9 vs 53.8 p = 0.004).ConclusionSIR parameters were associated with malnutrition, weight loss and hypoalbuminemia. Chemotherapy-induced toxicity in NSCLC patients treated with paclitaxel and cisplatin was associated with malnutrition and hypoalbuminemia. Early nutritional assessment and support might confer beneficial effects.

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Section: Discussionmentioning

confidence: 99%

Association of nutritional status and serum albumin levels with development of toxicity in patients with advanced non-small cell lung cancer treated with paclitaxel-cisplatin chemotherapy: a prospective study

et al. 2010

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“…Cachectic patients may lose > 50% of their preillness body weight, and the onset of malnutrition and inanition accelerates their demise. Advances in nutritional therapy have done little to alter the poor prognosis of this wasting diathesis, and its pathogenesis remains incompletely understood (6,7). It is known that normal regulation of food intake is severely deranged in cachexia; even when food is freely available the cachectic host does not consume enough to meet basal energy needs (1,7,8,9).…”

Section: Introductionmentioning

confidence: 99%

Metabolic effects of cachectin/tumor necrosis factor are modified by site of production. Cachectin/tumor necrosis factor-secreting tumor in skeletal muscle induces chronic cachexia, while implantation in brain induces predominantly acute anorexia.

Tracey¹,

Morgello²,

Koplin³

et al. 1990

J. Clin. Invest.

213

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We have developed a murine model of wasting by injecting intracerebrally cells which continuously secrete h-cachectin/ TNF (CHO-TNF) to: (a) determine the effects of cachectin/ TNF produced continuously in the central nervous system (CNS), and (b) compare the metabolic effects of cachectin/ TNF-secreting tumor in the brain to the cachexia caused by CHO-TNF tumor in peripheral tissue (IM). Intracerebral CHO-TNF tumors produced increased serum h-cachectin/ TNF levels with lethal hypophagia and weight loss (mean survival time of 11 d); these changes were not observed in association with nonsecretory control brain tumors. The metabolic consequences of intracerebral cachectin/TNF production were indistinguishable from acute, lethal starvation: whole-body lipid content was decreased significantly but protein was conserved. Although intramuscular cachectin/TNF-secreting tumors caused similar increases of serum h-cachectin/TNF levels, profound anorexia did not develop; wasting developed after a longer period of tumor burden (50 d) with classical signs of cachexia (i.e., anemia and depletion of both protein and lipid). These studies provide a reproducible animal model of site-specific cytokine production and suggest that, regardless of serum levels, cachectin/TNF produced locally in brain influences both the rate of development of wasting and its net metabolic effects. (J. Clin.

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Section: Discussionmentioning

confidence: 99%

A Case Report of Chemotherapy-induced Alopecia Treated with Bojungikki-tang

Lee¹

2017

J Int Korean Med

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Background: A frequent manifestation of advanced NSCLC is malnutrition, even though there are many studies which relate it with a poor survival, its relation with toxicity has not yet been consistently reported. The aim of this study was to associate malnutrition and albumin serum levels with the occurrence of chemotherapy-induced toxicity in cisplatin plus paclitaxel chemotherapy-treated NSCLC. Methods: We prospectively evaluated 100 stage IV NSCLC patients treated with paclitaxel (175 mg/m

show abstract

General Metabolic Abnormalities in Cancer Patients: Anorexia and Cachexia

Cited by 39 publications

References 34 publications

Association of nutritional status and serum albumin levels with development of toxicity in patients with advanced non-small cell lung cancer treated with paclitaxel-cisplatin chemotherapy: a prospective study

Association of nutritional status and serum albumin levels with development of toxicity in patients with advanced non-small cell lung cancer treated with paclitaxel-cisplatin chemotherapy: a prospective study

Metabolic effects of cachectin/tumor necrosis factor are modified by site of production. Cachectin/tumor necrosis factor-secreting tumor in skeletal muscle induces chronic cachexia, while implantation in brain induces predominantly acute anorexia.

A Case Report of Chemotherapy-induced Alopecia Treated with Bojungikki-tang

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