What pharmacologic interventions are available for the treatment of the cancer related anorexia-cachexia syndrome?
Resting energy expenditures are elevated, and increased intermediary metabolism, proteolysis, and lipolysis occur independently of caloric intake. An interaction between catecholamines, prostaglandins, and inflammatory cytokines seems to be responsible for cachexia. Thus, pharmacologic tretment should increase appetite and decrease metabolism. The first agents used in the management of anorexic cancer patients were corticosteroids such as dexamethasone, methylprednisolone, and prednisolone. These agents stimulate the appetite. The mechanism of action is unclear but may be due to their euphorigenic effects. The duration of appetite stimulation, however, is short and frequently requires increasing doses over time. Patients experience the usual adverse effects associated with chronic steroid use. Medroxyprogesterone and megestrol acetate have also been evaluated. Their mechanism of action may be related to their anabolic effects as well as to appetite stimulation. Most patients experience
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