Cancer cachexia: molecular mechanism and pharmacological management

Biochem J. 2021 May 14;478(9):1663-1688. doi: 10.1042/BCJ20201009.

Abstract

Cancer cachexia often occurs in malignant tumors and is a multifactorial and complex symptom characterized by wasting of skeletal muscle and adipose tissue, resulting in weight loss, poor life quality and shorter survival. The pathogenic mechanism of cancer cachexia is complex, involving a variety of molecular substrates and signal pathways. Advancements in understanding the molecular mechanisms of cancer cachexia have provided a platform for the development of new targeted therapies. Although recent outcomes of early-phase trials have showed that several drugs presented an ideal curative effect, monotherapy cannot be entirely satisfactory in the treatment of cachexia-associated symptoms due to its complex and multifactorial pathogenesis. Therefore, the lack of definitive therapeutic strategies for cancer cachexia emphasizes the need to develop a better understanding of the underlying mechanisms. Increasing evidences show that the progression of cachexia is associated with metabolic alternations, which mainly include excessive energy expenditure, increased proteolysis and mitochondrial dysfunction. In this review, we provided an overview of the key mechanisms of cancer cachexia, with a major focus on muscle atrophy, adipose tissue wasting, anorexia and fatigue and updated the latest progress of pharmacological management of cancer cachexia, thereby further advancing the interventions that can counteract cancer cachexia.

Keywords: anorexia; cancer cachexia; fatigue; muscle atrophy; pharmacotherapy.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adipose Tissue / drug effects
  • Adipose Tissue / metabolism
  • Adipose Tissue / pathology
  • Anorexia / complications
  • Anorexia / drug therapy*
  • Anorexia / metabolism
  • Anorexia / mortality
  • Anti-Inflammatory Agents / therapeutic use
  • Antineoplastic Agents / therapeutic use*
  • Appetite Stimulants / therapeutic use
  • Cachexia / complications
  • Cachexia / drug therapy*
  • Cachexia / metabolism
  • Cachexia / mortality
  • Fatigue / complications
  • Fatigue / drug therapy*
  • Fatigue / metabolism
  • Fatigue / mortality
  • Humans
  • Mitochondria / drug effects
  • Mitochondria / metabolism
  • Mitochondria / pathology
  • Muscle, Skeletal / drug effects
  • Muscle, Skeletal / metabolism
  • Muscle, Skeletal / pathology
  • Muscular Atrophy / complications
  • Muscular Atrophy / drug therapy*
  • Muscular Atrophy / metabolism
  • Muscular Atrophy / mortality
  • Neoplasms / complications
  • Neoplasms / drug therapy*
  • Neoplasms / metabolism
  • Neoplasms / mortality
  • Quality of Life
  • Survival Analysis
  • Testosterone Congeners / therapeutic use
  • Weight Loss / drug effects

Substances

  • Anti-Inflammatory Agents
  • Antineoplastic Agents
  • Appetite Stimulants
  • Testosterone Congeners