Cachexia in pancreatic cancer – Mechanisms and potential intervention

SummaryBackgroundPancreatic cancer (PaC) is associated with a particularly severe form of cachexia or wasting syndrome. A strong pro-inflammatory response, skeletal muscle wasting and peripheral insulin resistance all together contribute to increased morbidity and mortality. The aim of this review was to investigate mechanisms behind the development of cachexia in PaC.MethodsPubMed (NLM) was searched for articles on the development of cachexia in pancreatic cancer using the mesh terms: ‘pancreatic neoplasms’, ‘cachexia’ and ‘pancreatic diseases’. A systematic review of the articles was performed.Results72 articles between 1984 and 2008 were identified. Cachexia related to PaC is multifactorial and mediated by tumour-derived factors and pro-inflammatory cytokines. A considerable degree of genetic predisposition for a strong inflammatory response seems to exist, which correlate with an adverse effect on cachexia and survival in PaC.ConclusionsScreening for an acute-phase response and genetic susceptibility for a strong inflammatory response could potentially contribute to achieve both early diagnosis and intervention against cachexia and may also serve as a prognostic marker. Treatment of cachexia should be inserted early on, aiming at restoring energy and protein balance, and could include anti-inflammatory, as well as immunomodulating agents, together with physical mobilization of the patient.