Combination therapy in cachexia
Since Cancer cachexia is defined as a “multifactorial syndrome”, an effective therapeutic approach might be comprehensive multi-faceted treatment that targets different pathophysiological mechanisms simultaneously. The defining features of cancer cachexia, such as weight loss, reduced food intake, and chronic inflammation, might provide both a framework for classification of cachexia and a rationale for identifying multiple therapeutic targets. Past efforts to treat cachexia with nutritional or medical interventions may have disappointed because they were directed at a single domain of the syndrome, such as anorexia or muscle wasting, usually with a single therapeutic agent. Preliminary trials combining pharmacological and non-pharmacological therapy have been shown to be feasible and also to improve selected clinical outcomes. The choice of specific pharmacological agents has varied based on mechanistic considerations or on prior promising single intervention or multimodal trials. Despite the variations in therapy composition, most multimodal regimens share a common purpose in simultaneously modulating the major mechanisms causing cachexia, identifying patients early in the illness trajectory, and including supportive care measures such as symptom management, exercise, and nutritional counseling/supplementation.