Central tenet of cancer cachexia therapy: do patients with advanced cancer have exploitable anabolic potential?

Am J Clin Nutr. 2013 Oct;98(4):1012-9. doi: 10.3945/ajcn.113.060228. Epub 2013 Aug 21.


Background: Skeletal muscle wasting is considered the central feature of cachexia, but the potential for skeletal muscle anabolism in patients with advanced cancer is unproven.

Objective: We investigated the clinical course of skeletal muscle wasting in advanced cancer and the window of possible muscle anabolism.

Design: We conducted a quantitative analysis of computed tomography (CT) images for the loss and gain of muscle in population-based cohorts of advanced cancer patients (lung, colorectal, and pancreas cancer and cholangiocarcinoma) in a longitudinal observational study.

Results: Advanced-cancer patients (n = 368; median survival: 196 d) had a total of 1279 CT images over the course of their disease. With consideration of all time points, muscle loss occurred in 39% of intervals between any 2 scans. However, the overall frequency of muscle gain was 15.4%, and muscle was stable in 45.6% of intervals between any 2 scans, which made the maintenance or gain of muscle the predominant behavior. Multinomial logistic regression revealed that being within 90 d (compared with >90 d) from death was the principal risk factor for muscle loss (OR: 2.67; 95% CI: 1.45, 4.94; P = 0.002), and muscle gain was correspondingly less likely (OR: 0.37; 95% CI: 0.20, 0.69; P = 0.002) at this time. Sex, age, BMI, and tumor group were not significant predictors of muscle loss or gain.

Conclusions: A window of anabolic potential exists at defined early phases of the disease trajectory (>90 d survival), creating an opportunity for nutritional intervention to stop or reverse cachexia. Cancer patients within 90 d of death have a low likelihood of anabolic potential.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adipose Tissue / pathology
  • Aged
  • Body Composition
  • Cachexia / etiology
  • Cachexia / pathology*
  • Cachexia / therapy
  • Cholangiocarcinoma / complications
  • Cholangiocarcinoma / pathology
  • Colorectal Neoplasms / complications
  • Colorectal Neoplasms / pathology
  • Female
  • Humans
  • Longitudinal Studies
  • Lung Neoplasms / complications
  • Lung Neoplasms / pathology
  • Male
  • Metabolism
  • Middle Aged
  • Muscle, Skeletal / pathology*
  • Muscular Atrophy
  • Neoplasm Staging
  • Neoplasms / complications*
  • Neoplasms / mortality
  • Neoplasms / pathology
  • Pancreatic Neoplasms / complications
  • Pancreatic Neoplasms / pathology
  • Survival Rate
  • Tomography, X-Ray Computed