Cancer-associated weight loss: releasing its firm grip on negative clinical outcomes.
Cancer-associated weight loss: releasing its firm grip on negative clinical outcomes.
复制标题
癌症相关的体重减轻：释放对负面临床结果的牢牢控制。
DOI：
10.1097/spc.0000000000000297
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发表时间：
2017
影响因子：
2.1
通讯作者：
Jatoi,Aminah
中科院分区：
文献类型：
--
作者：
Yusuf,Naima;Jatoi,Aminah
治疗晚期癌症患者减肥的未来是什么？在过去的5年里，在治疗癌症相关的体重减轻综合征方面取得了巨大的失望。正如加西亚（pp. 266-271）在本期《支持和姑息治疗的当前观点》中，两项大型注册试验，总共包括1500多名患者，估计花费1亿美元，未能实现其主要双重终点[1，2]。这些试验--一项测试了选择性雄激素受体调节剂enobosarm，另一项测试了口服胃促生长素模拟物anamorelin--都没有产生可处方的药物，得出同样的停滞结论，即使用较旧的药物进行适度缓解，例如黄体酮和皮质类固醇，仍然是选择患有无法治愈的恶性肿瘤的减肥癌症患者的唯一经过验证的治疗方法[3，4]。例如，在阿拉莫林试验中，手握力没有改善导致了失望。从本质上讲，在过去的40年里，治疗无法治愈的癌症患者的癌症相关体重减轻的护理标准保持不变。因此，上面提出的问题不仅具有挑衅性，而且是相关和及时的。在本期杂志中，研究人员开始进一步思考这个问题。总结了以前发表的数据，刘和艾扬格（pp. 261-265）采取了新的方法，专注于正在接受放射治疗的癌症患者的体重减轻。直到最近，Fakhry et al. [5]另一项类似的研究观察了600多名口咽癌患者的放射治疗，并观察到体重减轻与较短的癌症无进展生存期有关。这些研究与无数其他研究一起得出了完全相同的结论：癌症患者的体重减轻与不良临床结果有关。然而，这种对接受放射治疗的癌症患者的关注是创新的;它引起了对癌症患者的关注，这些癌症患者经常接受积极的多模态治疗，遭受高比率的严重体重减轻，并且由于每天前往诊所接受放射治疗而似乎是治疗干预的俘虏观众，以帮助管理体重减轻。对这组患者进行严格研究的工作相对较少。在他们的文章中，Lau和Iyengar（pp. 261-265）已经为接受辐射的患者中癌症相关体重减轻的未来干预性试验奠定了基础。同样在这个问题上，邓恩等人。（第100页）278-286）表明，运动值得进一步研究，以治疗癌症相关的体重减轻。事实上，这些研究人员已经率先在癌症患者中开展了运动计划。完成了一项招募老年前列腺癌患者的三组随机小型试点研究，这些研究人员测试了基于家庭的步行和阻力训练干预与技术介导的步行和阻力干预与标准护理[6]。与标准护理相比，这些运动干预产生了一些非常早期的承诺信号，但首先，这些研究人员证明了可行性。重要的是，这种可行性的证明本身就是一个突出的成就，特别是当其他研究人员对减肥癌症患者的运动研究犹豫不决时，他们发表了题为“癌症恶病质患者缺乏进行定期结构化锻炼的动机和自我效能”的研究。此外，在减肥癌症患者中实施运动干预似乎具有挑战性：筛选患者...
What does the future hold for treating weight loss in advanced cancer patients? The past 5 years have yielded immense disappointment in efforts to treat the cancer-associated weight loss syndrome. As reviewed by Garcia (pp. 266–271) in this issue of Current Opinions in Supportive and Palliative Care, two large registration trials, which, in total, included over 1500 patients and cost an estimated $100 million, failed to achieve their primary dual endpoints [1, 2]. Neither of these trials–one which tested the selective androgen receptor modulator, enobosarm, and the other which tested the oral ghrelin mimetic, anamorelin–resulted in a prescribable agent, leading to the same stagnant conclusion that modest palliation with older agents, such as progesterones and corticosteroids, remains the only proven therapeutic approach for select weight-losing cancer patients with an incurable malignancy [3, 4]. For example, in the anamorelin trials, it was an absence of improvement in hand grip strength that led to disappointment. In essence, over the past 4 decades, the standard of care for treating cancer-associated weight loss in incurable cancer patients remains unchanged. Hence, the question posed above is not only provocative but also relevant and timely. In this issue of the journal, investigators begin to ponder this question further. Summarizing a compendium of previously published data, Lau and Iyengar (pp. 261–265) take the novel approach of focusing on weight loss in cancer patients who are receiving radiation. Only recently, Fakhry et al.[5] added yet another such study that looks at radiation in over 600 patients with oropharyngeal cancer and observed that weight loss is associated with shorter cancer progression-free survival. Such studies join countless others that have reached the exact same conclusion: weight loss in cancer patients is associated with poor clinical outcomes. However, this focus on radiation-treated cancer patients is innovative; it draws attention to cancer patients who often receive aggressive multimodality therapy, suffer high rates of severe weight loss, and yet appear to be a captive audience for a therapeutic intervention to help manage weight loss because of daily travel to the clinic to receive radiation treatments.Furthermore, relatively little has been done to rigorously study this group of patients. In their thorough article, Lau and Iyengar (pp. 261–265) have put in place the groundwork for future interventional trials for cancer-associated weight loss in patients receiving radiation. Also in this issue, Dunne et al.(pp. 278–286) suggest that exercise merits further study to treat cancer-associated weight loss. Indeed, these investigators have spearheaded exercise programs in cancer patients. Completing a three-arm randomized, small pilot study that recruited older patients with prostate cancer, these investigators tested a homebased walking and resistance training intervention versus a technology-mediated walking and resistance intervention versus standard care [6]. These exercise interventions generated some very early signals of promise compared to standard care, but, first and foremost, these investigators demonstrated feasibility. Importantly, this demonstration of feasibility is a salient achievement in its own right, particularly when other investigators have been hesitant to study exercise in weight-losing cancer patients and when instead they have published studies entitled, for example,‘Patients with Established Cancer Cachexia Lack the Motivation and Self-Efficacy to Undertake Regular Structured Exercise’[7]. Moreover, implementing exercise interventions in weight-losing cancer patient appears challenging: screening patients …
影响因子：
45.3
作者：
Jatoi, A;Windschitl, HE;Christensen, B
通讯作者：
Christensen, B
患有癌症恶病质的患者缺乏进行定期结构化锻炼的动力和自我效能
影响因子：
3.6
作者：
D. Wasley;N. Gale;S. Roberts;K. Backx;A. Nelson;R. V. van Deursen;A. Byrne
通讯作者：
A. Byrne
影响因子：
45.3
作者：
Fakhry, Carole;Zhang, Qiang;Gillison, Maura L.
通讯作者：
Gillison, Maura L.