Pharmacologic Options for the Treatment of Cachexia

Anorexia and cachexia are prevalent and devastating complications of acquired immunodeficiency syndrome (AIDS) and cancer. Cachexia causes not only loss of body mass, but also decreased energy, decreased therapy tolerance, and increased infection susceptibility, all of which lead to a decreased quality of life. Metabolic abnormalities and decreased appetites seem to be responsible for weight loss in cachectic individuals. The release of cytokines has been found to correlate with weight loss and severe anorexia in animal models. The data in humans is not strong as there are problems in the technical aspects of measuring cytokine levels. Agents such as corticosteroids, anabolic steroids, appetite stimulants, progestational agents, metabolic inhibitors, and anticytokine therapy have been studied for AIDS wasting syndrome and cancer cachexia. Megestrol acetate, a progestational appetite stimulant, has shown the most promise for the treatment of both cancer and AIDS‐related cachexia. Recent literature suggests that agents such as growth hormone, insulin‐like growth factor, and thalidomide may stimulate lean body mass gain rather than fat mass gain. Further study is needed to define the roles of these agents for the treatment of cachexia.