Cancer cachexia and immunomodulation.

Cachexia is derived from the Greek words "kakos" meaning "bad" and "hexis" meaning "condition". Cachexia is a debilitating state of involuntary weight loss complicating malignant, infectious and inflammatory diseases. Several hypotheses for its etiology have been suggested including cytokines, circulating hormones, neuropeptides, neurotransmitters, and tumor-derived factors. Cachexia syndrome is caused predominantly by cytokines either produced by cancer or released by the immune system cells as a response to the presence of cancer, as well as other tumor products that induce profound lipolysis or protein degradation. Several strategies have been applied in the management of cachexia and related immunodeficiency including: 1.hypercaloric feeding;2.administration of glucocorticoids;3.progrestational drugs;4.cyproheptadine and other antiserotonergic drugs;5.branched-chain aminoacids;6.prokinetic agents;7.eicosapentanoic acid (EPA);8.cannabinoids;9.5'-deoxy-5-fluorouridine;10.emerging drugs: melatonin, thalidomide, beta2-agonists, non-steroidal anti-inflammatory drugs (NSAIDs);11.others:pentoxifylline, hydrazine sulfate, anabolic steroids. Better understanding of the mechanisms underlying cancer and cachexia leading to immune dysfunction has guided immunomodulatory strategies to reverse cachexia and immunodeficiency. The oncept is that the tumor itself may lead to cachexia and immune dysfunction but also cachexia is related and mediated with immune dysfunction. Thus the purpose is to affect the tumor itself and cachexia immune pathways in order to restore immune efficiency. However, more experimental and clinical studies are needed to evaluate the efficacy of immunomodulatory intervention in cancer cachexia and related immunodeficiency.