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Cachexia

Treat wasting illness on multiple fronts

Cachexia is a complex wasting syndrome that cannot be fully reversed by nutritional support alone (see, for example, Nature 528, 182–183; 2015). There is accumulating evidence that a comprehensive multimodal approach may succeed where unimodal treatments (such as nutrition or anabolic drugs) have failed to deliver extended clinical benefits. Support for a multimodal policy comes from established rehabilitation programmes (see, for example, M. A. Spruit et al. Am. J. Respir. Crit. Care Med. 188, e13–e64; 2013).

The failure of the classical unimodal approach suggests that a shift in clinical-trial design is needed (K. C. H. Fearon et al. J. Cachexia Sarcopenia Muscle 6, 272–274; 2015). This could include monitoring the combined effects of exercise and nutrition, along with controlling metabolism and systemic inflammation. These interventions would need to be tested early, before cachexia becomes irreversible.

The complexity of such interventions makes them difficult to organize and fund. They would require input from research, government, pharmaceutical companies and regulatory authorities. However, the possible clinical benefits stand to improve the quality and, in the long term, perhaps even the quantity of patients' lives.

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Correspondence to Kenneth Fearon.

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K.F. has received lecture fees, consultancy fees, research support or attended advisory boards for Nutricia, Abbot, Fresenius Kabi, Lily, Helsinn, Chugai, Ono, Novartis and Aveo Oncology.

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Fearon, K. Treat wasting illness on multiple fronts. Nature 529, 156 (2016). https://doi.org/10.1038/529156b

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