Treatment of cancer cachexia in the very advanced or terminal phase: a systematic review

The therapeutic approach to refractory cancer cachexia represents an unmet need and an important research priority in the field of palliative care. Unfortunately, clinical studies in this area are scarce, both regarding nutritional and pharmacological approach. We performed a systematic literature search through Pubmed. The search algorithm considered: the clinical context, the related pathology, the therapeutic approach. The abstracts obtained were entered in a spreadsheet and analyzed in full text. The results were then analyzed according to the PRISMA method. Overall, 258 records were screened: 244 were excluded (not in English, n=44; no abstract, n=12; literature reviews, n=108; not relevant for not advanced phase or phase II studies, n=80). The remaining 14 papers were read in full text: 10 were excluded (4 phase II studies, 4 including patients with a performance status score of ‰¥70%, 2 including patients concomitantly treated by palliative chemotherapy). The remaining 4 studies of qualitative synthesis included: a study on megestrol acetate; a comparison between supportive treatment with/without melatonin; a placebo-controlled study on intravenous adenosine 5'-triphosphate; a comparison of indomethacin plus erythropoietin with/without nutritional support. The reported data do not allow us to draw any conclusion concerning the efficacy of pharmacological or nutritional treatment for cancer cachexia in very advanced or terminal phase and specific studies are, therefore, awaited.