Cachexia in Lung Cancer: A Barrier to Effective Treatment

Cachexia is a muscle wasting syndrome that can affect cancer patients of any stage. Cachexia can lead to decreased quality of life, progressive functional decline, and poor tolerance to cancer therapies.

Cachexia

• affects about 50% of lung cancer patients and up to 80% of people with late-stage cancer
• directly cause one-third of deaths among cancer patients

Cachexia is characterized by

• involuntary weight loss, primarily due to muscle loss, but also fat
• loss of appetite
• fatigue
• physical weakness that make routine activities difficult

Recent advancements have made a handful of treatments available, even for advanced-stage lung cancer patients with tumors spread to other body parts. Doctors might order surgery, chemotherapy, targeted therapy, immunotherapy, or a combination of these treatments.

Unfortunately, those with cachexia may not have the same response to emerging cancer treatments compared to those who don’t.

Lung cancer patients with cachexia may not be suited for certain treatments until their nutritional status improves or their overall condition stabilizes, and often a shift in treatment priorities is needed in order to directly address cachexia and its related symptoms before cancer treatment can resume.

Addressing cachexia in cancer patients is essential to improving their overall health and increasing their chances of successfully undergoing cancer treatments. The physical effects of cachexia should be directly treated by supportive care clinicians, including

• improving diet
• providing a prescription for physical therapy/exercise/rehabilitation to improve physical function
• addressing related nutritional intake symptoms such as nausea, vomiting, diarrhea, and loss of appetite through newly emerging medications

A multi-disciplinary approach to cachexia is needed in order to see improvements in quality of life and function.

In the U.S., there are no FDA-approved treatments available for cancer cachexia as of now, though numerous medications are being used off-label to stimulate appetite or address nutrition-intake symptoms. However, in 2021, Japanese health authorities approved a medication called anamorelin to address this condition.

Anamorelin works by mimicking the actions of a hormone known as ghrelin. Released by stomach cells, this hormone stimulates the desire to eat and enhances one's appetite. Presently, anamorelin is in the midst of clinical trials in the United States, Europe, Russia, and Australia as a potential treatment for cachexia in advanced non-small cell lung cancer (NSCLC) patients.

Studies have also found that a widespread cancer-related inflammation causes the underlying biology of cancer cachexia. Currently, several experimental drugs target inflammation-associated cachexia being tested in human studies.

It is crucial for patients to be aware of the signs of cachexia and to communicate any changes or concerns with their cancer care team. They will provide advice on how to deal with cachexia appropriately and take the necessary steps to manage it.