Muscle wasting in cancer: opportunities and challenges for exercise in clinical cancer trials.
Muscle wasting in cancer: opportunities and challenges for exercise in clinical cancer trials.
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DOI：
10.1002/rco2.56
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发表时间：
2022-01
影响因子：
--
通讯作者：
Murphy, Angela E
中科院分区：
文献类型：
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作者：
Fairman, Ciaran M;Lonbro, Simon;Cardaci, Thomas D;VanderVeen, Brandon N;Nilsen, Tormod S;Murphy, Angela E
癌症中肌肉含量低与治疗相关毒性增加相关，并且是癌症相关和全因死亡率的预测因子。癌症相关的肌肉损失的机制是多因素的，包括厌食症、性腺功能减退、贫血、炎症、营养不良和骨骼肌蛋白质周转和代谢的异常。在这篇叙述性综述中，我们总结了相关文献，以（i）审查影响骨骼肌质量调节的因素，（ii）概述癌症/治疗如何对这些产生负面影响，（iii）审查肌肉信号传导以外的因素，这些因素可能影响参与和应对运动干预的能力，以抵消癌症中的肌肉损失，以及（iv）提供未来研究的关键领域的观点。尽管运动的益处众所周知，但仍然缺乏临床证据支持运动对癌症相关肌肉损失的影响。在临床癌症环境中通过运动逆转肌肉损失存在许多挑战，范围从癌症/治疗对肌肉质量的分子调节的影响到对运动干预的反应性的临床挑战。例如，肿瘤相关/治疗相关因素（例如恶心、疼痛、贫血和中性粒细胞减少症）、合并症（例如糖尿病、关节炎和慢性阻塞性肺病）的存在、损伤、疾病进展和骨转移、合并用药（例如，二甲双胍），可能会对个体的安全锻炼能力产生负面影响，并限制随后的适应。这篇评论确定了许多差距和机会，在该地区的低肌肉和肌肉损失的癌症。临床前和临床研究人员之间的合作对于了解萎缩的机制和开发适当的治疗干预措施至关重要。
Low muscle in cancer is associated with an increase in treatment-related toxicities and is a predictor of cancer-related and all-cause mortality. The mechanisms of cancer-related muscle loss are multifactorial, including anorexia, hypogonadism, anaemia, inflammation, malnutrition, and aberrations in skeletal muscle protein turnover and metabolism. In this narrative review, we summarise relevant literature to (i) review the factors influencing skeletal muscle mass regulation, (ii) provide an overview of how cancer/treatments negatively impact these, (iii) review factors beyond muscle signalling that can impact the ability to participate in and respond to an exercise intervention to counteract muscle loss in cancer, and (iv) provide perspectives on critical areas of future research. Despite the well-known benefits of exercise, there remains a paucity of clinical evidence supporting the impact of exercise in cancer-related muscle loss. There are numerous challenges to reversing muscle loss with exercise in clinical cancer settings, ranging from the impact of cancer/treatments on the molecular regulation of muscle mass, to clinical challenges in responsiveness to an exercise intervention. For example, tumour-related/treatment-related factors (e.g. nausea, pain, anaemia, and neutropenia), presence of comorbidities (e.g. diabetes, arthritis, and chronic obstructive pulmonary disease), injuries, disease progression and bone metastases, concomitant medications (e.g., metformin), can negatively affect an individual’s ability to exercise safely and limit subsequent adaptation. This review identifies numerous gaps and oppportunities in the area of low muscle and muscle loss in cancer. Collaborative efforts between preclinical and clinical researchers are imperative to both understanding the mechanisms of atrophy, and develop appropriate therapeutic interventions.