20 december 2016: Bron: World J Gastrointest Oncol. 2015 Apr 15; 7(4): 17–29.

Wanneer kankerpatiënten in een gevorderd stadium van hun ziekte verkeren krijgen ze bijna altijd te maken met sterke vermagering, ook wel cahexie genoemd. Ook chemokuren en nieuwe medicijn combinaties binnen personalised medicine veroorzaken vaak sterke vermagering. Uit de literatuur blijkt dat 20 procent ook vroegtijdig overlijdt mede door die sterke vermagering. De laatste jaren echter zijn er wel behandelingen gevonden die die vermagering tegengaan. Met als effect dat de kwaliteit van leven verbetert en het ook invloed heeft op de overall overleving.

In de literatuurlijsten van arts-bioloog drs. Engelbert Valstar staan ook per kankersoort of naast chemo studies vermeld van niet-toxische voedingsstoffen die vermagering tegengaan. Maar ook in de reguliere oncologie zijn er inmiddels wel synthethische stoffen / medicijnen die die vermagering kunnen tegengaan.

In dit studierapport: Cancer cachexia, mechanism and treatment worden een aantal behandelingen / middelen tegen cahexie beschreven. Zie o.a. de groen gemaakte sleutelwoorden.

Tekst gaat verder onder foto.

cachexie

Bron foto: Medical facts:

http://www.medicalfacts.nl/2013/08/28/maastrichts-onderzoek-biedt-perspectief-voor-longkankerpatienten-met-spiermassaverlies/

cahexie mechanisme

In bovenstaande grafiek wordt aangegeven hoe dat proces van vermagering precies werkt. Hoe de verschillende behandelingen, medicijnen en niet-toxische stoffen werken en ook met verwijzing naar studies met die aanpak is te zien in onderstaande tabel. Deze worden ook besproken in het studierapport. Hoewel het voor leken wel ingewikkeld is lijkt mij. Maar u zou het altijd eens voor kunnen leggen aan uw behandelend arts.

Een ander Nederlands onderzoek is ook interessant om te lezen hoe vermagering plaatsvindt bij loingkankerpatiënten en wat daar tegen te doen: Maastrichts onderzoek biedt perspectief voor longkankerpatiënten met spiermassaverlies

Tekst gaat verder onder grafiek

Table 1

Cancer cachexia

Treatment	Description	Physiologic benefit	Possible mechanism	Ref.
Megestrol acetate	Active progesterone derivative	Improves appetite, caloric intake, nutritional status, quality of life	Unknown; possible neuropeptide Y release	[80-92]
Medroxyprogesterone	Active progesterone derivative	Improves appetite, food intake Weight stabilization	Decreases serotonin, IL-1, IL-6, TNF-α	[93-96]
Ghrelin	Gastric peptide hormone	Improves lean + total body mass, hand grip, cardiac function (CHF cachexia only)	Growth hormone receptor secretagogue
Delta-9-tetrahydrocannabinol	Cannabinoid	MIXED May improve food intake, weight gain	Possible endorphin receptor activation, Inhibition of prostaglandin, IL-1	[85,106-110]
Melanocortin antagonists	Adrenocorticotropic hormone antagonist	UNTESTED; prevention of anorexia, loss of lean body mass or basal energy (animal only)	Neuropeptide Y alteration or melanocortin-4 receptor antagonism	[112,113]
Thalidomide	Immunomodulatory	Limits weight and lean body mass loss	Decreases TNF-α, pro-inflammatory cytokines, nuclear factor kappa B, cyclooxygenase 2, angiogenesis	[124-126]
Etanercept	Immunomodulatory	Limits fatigue; improves adjuvant therapy adherence	Decreases TNF effect
Eicosapentaenoic acid/omega-3-fatty acids	Lipid	MIXED; may improve weight, appetite, quality of life	Decreases pro-inflammatory cytokines, proteolysis inducing factor	[129,130,133,137,140-142,146-152]
Rikkun-shito	Herbal Japanese medicine	Improves median survival with gemcitabine (pancreatic cancer); improves anorexia, GI dysmotility, muscle wasting, anxiety	Unknown	[154,155]
Corticosteroids	Immunomodulatory	Improves appetite and quality of life	Various mechanisms	[156,157]
Formoterol	β2-adrenergic agonist	UNTESTED	Protein and muscle degradation antagonism
Erythropoetin	Glycoprotein hormone	Improves patient’s metabolic and exercise capacity	Decreases production of IL-6	[171-173]
ACE inhibitors	Heart medications	Reduce wasting of muscle mass	Inhibit TNF-α production
β-blockers	Heart medications	Preserved body weight, and lean and fat mass, and improved the quality of life	Normalized Akt phosphorylation

IL: Interleukin; TNF: Tumor necrosis factor.

In het studierapport komen de onderzoekers tot de volgende conclusie:

CONCLUSIE

Vermagering - cahexie door kanker wordt tot nu toe gezien als een ongeneeslijke vorm van de ziekte en leidt tot vroegtijdig overlijden bij 20% van alle kankerpatiënten. Het behandelen van cahexie is echter de laatste jaren sterk verbetert en de ontwikkeling en mechanismes die leiden tot progressie van deze aandoening worden steeds verder ontrafelt. Momenteel worden alle behandelingen voor kanker cachexie beschouwd als palliatief, maar nieuwe medicijnencombinaties verbeteren sterk de overleving en de kwaliteit van leven van de kankerpatiënt. Reguliere antineoplastische middelen hebben het vermogen om kanker te behandelen, maar in veel gevallen verslechteren deze het proces van vermagering. Toekomstige vooruitgang op dit gebied zal worden gerealiseerd door middel van de ontwikkeling van nieuwe aanvullende behandelingen met medicijnen die de progressie van kanker beïnvloeden alsmede de kwaliteit van leven van de kankerpatiënt verbetert.

Het volledige studierapport: Cancer cachexia, mechanism and treatment is gratis in te zien met een interessante referentielijst met doorklikbare links naar betreffende studierapporten.

Mocht u kanker-actueel de moeite waard vinden en ons willen ondersteunen om kanker-actueel online te houden dan kunt u ons machtigen voor een periodieke donatie via donaties: https://kanker-actueel.nl/NL/donaties.html of doneer al of niet anoniem op - rekeningnummer NL79 RABO 0372931138 t.n.v. Stichting Gezondheid Actueel in Amersfoort. Onze IBANcode is NL79 RABO 0372 9311 38
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Hier het abstract met referentielijst van de beschreven studie hierboven:

Combination therapy with diet modification and/or exercise has been added to novel pharmaceutical agents, such as Megestrol acetate, medroxyprogesterone, ghrelin, omega-3-fatty acid among others. These agents are reported to have improved survival rates as well as quality of life. In this review, we will discuss the emerging understanding of the mechanisms of cancer cachexia, the current treatment options including multidisciplinary combination therapies, as well an update on new and ongoing clinical trials.

. 2015 Apr 15; 7(4): 17–29.

Published online 2015 Apr 15. doi: 10.4251/wjgo.v7.i4.17

PMCID: PMC4398892

Cancer cachexia, mechanism and treatment

Tomoyoshi Aoyagi, Krista P Terracina, Ali Raza, Hisahiro Matsubara, and Kazuaki Takabe

Author information ► Article notes ► Copyright and License information ►

This article has been cited by other articles in PMC.

Abstract

It is estimated that half of all patients with cancer eventually develop a syndrome of cachexia, with anorexia and a progressive loss of adipose tissue and skeletal muscle mass. Cancer cachexia is characterized by systemic inflammation, negative protein and energy balance, and an involuntary loss of lean body mass. It is an insidious syndrome that not only has a dramatic impact on patient quality of life, but also is associated with poor responses to chemotherapy and decreased survival. Cachexia is still largely an underestimated and untreated condition, despite the fact that multiple mechanisms are reported to be involved in its development, with a number of cytokines postulated to play a role in the etiology of the persistent catabolic state. Existing therapies for cachexia, including orexigenic appetite stimulants, focus on palliation of symptoms and reduction of the distress of patients and families rather than prolongation of life. Recent therapies for the cachectic syndrome involve a multidisciplinary approach. Combination therapy with diet modification and/or exercise has been added to novel pharmaceutical agents, such as Megestrol acetate, medroxyprogesterone, ghrelin, omega-3-fatty acid among others. These agents are reported to have improved survival rates as well as quality of life. In this review, we will discuss the emerging understanding of the mechanisms of cancer cachexia, the current treatment options including multidisciplinary combination therapies, as well an update on new and ongoing clinical trials.

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