Pharmacological management of cachexia in adult cancer patients: a systematic review of clinical trials.
Pharmacological management of cachexia in adult cancer patients: a systematic review of clinical trials.
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DOI：
10.1186/s12885-018-5080-4
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发表时间：
2018-11-27
期刊：
影响因子：
3.8
通讯作者：
Jafri SH
中科院分区：
文献类型：
--
作者：
Advani SM;Advani PG;VonVille HM;Jafri SH
恶病质是一种多系统综合征，其特征在于体重减轻、厌食、肌肉质量损失、全身性炎症、胰岛素抵抗和功能下降。恶病质的管理涉及解决多种潜在的生物学机制。先前关于癌症恶病质的药物管理的综述确定孕激素和皮质类固醇是治疗恶病质的有效药物。然而，迄今为止，对于恶病质管理的单一有效或标准治疗还没有达成共识。本系统评价的目的是确定药物治疗用于管理成人癌症患者恶病质的有效性。我们对PubMed（NLM）、Embase（奥维德）和Medline（奥维德）进行了文献检索，以识别2004年至2018年期间关注成人癌症患者癌症恶病质药物管理的临床试验。三名评审员筛选了随机选择的摘要，以衡量评分者间的可靠性。在这一步之后，每个筛选者筛选了所有摘要的三分之二，并确定了177项研究进行全文审查。主要结果是药物治疗对癌症患者体重或瘦体重变化的影响。我们确定了19篇文章（代表20项随机对照试验），重点是癌症恶病质的药物管理。显示出有希望的结果的药剂包括阿拉莫林和Enobosarm。在所有研究中，每天50或100 mg的阿拉莫林持续12周显示出一致的益处，并且与癌症患者的基线相比，体重显著改善。Enobosarm每天1和3 mg也可有效改善晚期癌症患者的瘦体重和QOL症状。最后，使用联合药物为靶向恶病质机制的多个途径以实现最大获益提供了证据。没有药物在癌症患者中显示出功能改善。阿拉莫林作为单一药剂在改善癌症患者中恶病质相关的体重减轻方面显示出有希望的结果。对联合治疗的进一步研究可能有助于解决恶病质管理的关键差距。本文的在线版本（10.1186/s12885-018-5080-4）包含补充材料，可供授权用户使用。
Cachexia is a multisystem syndrome characterized by weight loss, anorexia, loss of muscle mass, systemic inflammation, insulin resistance, and functional decline. Management of cachexia involves addressing multiple underlying biological mechanisms. Previous review on pharmacological management of cancer cachexia identified progestins and corticosteroids as effective agents for treatment of cachexia. However, to date no consensus exists on a single effective or standard treatment for management of cachexia. The aim of this systematic review is to determine the effectiveness of pharmacological treatments used to manage cachexia among adult cancer patients. We performed literature searches of PubMed (NLM), Embase (Ovid), and Medline(Ovid) to identify clinical trials focused on pharmacological management of cancer cachexia among adult cancer patients from 2004 to 2018. Three reviewers screened a random selection of abstracts to measure for interrater reliability. After this step, each screener screened two-thirds of all abstracts and 177 studies were identified for full text review. The primary outcome was impact of pharmacological management on change in either weight or lean body mass in cancer patients. We identified 19 articles (representing 20 RCTs) that focused on pharmacological management of cancer cachexia. Agents showing promising results included Anamorelin and Enobosarm. Anamorelin at 50 or 100 mg per day for 12 weeks showed a consistent benefit across all studies and resulted in significant improvement in weight as compared to baseline among cancer patients. Enobosarm at 1 and 3 mg per day was also effective in improving lean body mass and QOL symptoms among advancer stage cancer patients. Finally, use of combination agents provide evidence for targeting multiple pathways underlying cachexia mechanism to achieve maximum benefit. No agents showed functional improvement in cancer patients. Anamorelin as a single agent shows promising results in improving cachexia related weight loss among cancer patients. Further research on combination therapies may be helpful to address critical gaps in cachexia management. The online version of this article (10.1186/s12885-018-5080-4) contains supplementary material, which is available to authorized users.
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DOI：
10.2147/dddt.s110131
发表时间：
2017
期刊：
Drug design, development and therapy
影响因子：
--
作者：
Graf SA;Garcia JM
通讯作者：
Garcia JM
DOI：
10.1016/j.lungcan.2009.06.020
发表时间：
2010-05
期刊：
Lung cancer (Amsterdam, Netherlands)
影响因子：
--
作者：
Jatoi A;Ritter HL;Dueck A;Nguyen PL;Nikcevich DA;Luyun RF;Mattar BI;Loprinzi CL
通讯作者：
Loprinzi CL
影响因子：
51.1
作者：
Garcia, Jose M.;Boccia, Ralph V.;Friend, John
通讯作者：
Friend, John
影响因子：
1.9
作者：
Kanat, Ozkan;Cubukcu, Erdem;Olmez, Fatih
通讯作者：
Olmez, Fatih
影响因子：
4.8
作者：
Doyle, Alexander;Zhang, Guohua;Li, Yi-Ping
通讯作者：
Li, Yi-Ping