{"entity":{"id":"cachexia","kind":"term","name":"Cancer cachexia","aka":["Cancer wasting","Cancer anorexia-cachexia syndrome"],"tldr":"Severe loss of weight and muscle in advanced cancer that eating more cannot reverse on its own. It affects up to eight in ten patients with advanced disease and contributes to a fifth of cancer deaths.","summary":"International consensus (Fearon 2011): weight loss over 5% in six months, or over 2% with BMI under 20 or sarcopenia, driven by tumour- and host-derived inflammatory mediators (IL-6, TNF, activin, GDF-15) that suppress appetite and increase muscle and fat catabolism. Staged as precachexia, cachexia and refractory cachexia. Distinct from starvation because it is inflammation-driven and only partly nutrition-responsive; treatment is multimodal (nutrition, exercise, anti-inflammatory or appetite drugs). GDF-15 blockade is the first mechanism-based therapy in phase 3.","asOf":"2026-09-08","wikipedia":"https://en.wikipedia.org/wiki/Cachexia","links":[{"label":"Fearon consensus (Lancet Oncol 2011)","url":"https://doi.org/10.1016/S1470-2045(10)70218-7"},{"label":"Hendifar, Oncologist 2019: pancreas cancer-associated weight loss","url":"https://doi.org/10.1634/theoncologist.2018-0266"},{"label":"Bachmann, J Gastrointest Surg 2008: cachexia worsens prognosis in resectable pancreatic cancer (227 patients)","url":"https://doi.org/10.1007/s11605-008-0505-z"},{"label":"J Cachexia Sarcopenia Muscle 2019: the IMPACT study, early loss of skeletal muscle mass in advanced pancreatic cancer","url":"https://doi.org/10.1002/jcsm.12368"},{"label":"Pancreatic Cancer UK: diet and pancreatic cancer","url":"https://www.pancreaticcancer.org.uk/information-and-support/managing-symptoms-and-side-effects/diet-and-pancreatic-cancer/"},{"label":"Cancer Research UK: controlling symptoms of advanced pancreatic cancer","url":"https://www.cancerresearchuk.org/about-cancer/pancreatic-cancer/treatment/controlling-symptoms"},{"label":"Roeland et al., management of cancer cachexia, ASCO guideline (JCO 2020)","url":"https://doi.org/10.1200/JCO.20.00611"},{"label":"Muscaritoli et al., ESPEN practical guideline: clinical nutrition in cancer (Clinical Nutrition 2021)","url":"https://doi.org/10.1016/j.clnu.2021.02.005"},{"label":"Cancer Research UK: coping with breathlessness when you have lung cancer","url":"https://www.cancerresearchuk.org/about-cancer/lung-cancer/living-with/coping-with-breathlessness"},{"label":"NICE NG122: lung cancer, palliative interventions and supportive and palliative care","url":"https://www.nice.org.uk/guidance/ng122/chapter/Palliative-interventions-and-supportive-and-palliative-care"}],"tags":[],"related":[],"cancers":["pancreatic","nsclc","gastric","lung-cancer","sclc"],"sections":[],"technologies":["cachexia-therapy","cachexia-appetite-pharmacotherapy","resistance-training-cachexia","oncology-nutrition"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":["cachexia-biology"],"terms":["pancreatic-enzyme-replacement"],"trials":[],"people":[],"bottlenecks":["b-cachexia-supportive"],"keyPapers":["paper-fearon-lancet-oncol"],"journals":["journal-of-cachexia-sarcopenia-and-muscle"],"dependsOn":[],"notes":["Pancreatic cancer is the archetype: 85 percent of patients meet the classic definition of cancer cachexia (Hendifar 2019); 40.5 percent of 227 patients scheduled for resection were already cachectic, and their resection rate was 48.9 against 77.8 percent because metastases were found more often (Bachmann 2008); 73 percent of 94 advanced patients were sarcopenic at baseline and 21 percent lost 10 percent or more of skeletal muscle by the first restaging scan (IMPACT study 2019).","Malabsorption from exocrine insufficiency adds to cachexia in this cancer, so pancreatic enzyme replacement is part of the treatment (NICE NG85 1.6); fish oils are not recommended for weight loss in unresectable disease (1.6.3).","Pancreatic cancer: weight loss has two causes that need separating, undigested food (too few pancreatic enzymes) and the cancer's own effect on appetite and muscle. Pancreatic Cancer UK says PERT can make a big difference and that you do not need a special diet; Cancer Research UK says eat little and often, choose high-calorie and high-protein foods, and ask the dietitian about prescribed supplement drinks.","The ASCO cachexia guideline (Roeland 2020) recommends dietary counselling and says no drug is established for cancer cachexia; NICE NG85 says do not offer fish oils to manage weight loss in unresectable pancreatic cancer.","Lung cancer: Cancer Research UK says the muscles that help with breathing can become weaker in some people with lung cancer, often because of cachexia, a complex change in the body causing loss of muscle and often fat, which is one reason breathlessness and weight loss travel together. NICE NG122 (1.18.1) says weight loss, loss of appetite, depression and difficulty swallowing should be managed by multidisciplinary groups that include supportive and palliative care professionals."],"category":"Nutrition & lifestyle"},"route":"/terms/cachexia/","neighbours":{"cancer":[{"id":"gallbladder","kind":"cancer","name":"Gallbladder cancer","route":"/cancers/gallbladder/"},{"id":"gastric","kind":"cancer","name":"Gastric & gastro-oesophageal junction cancer","route":"/cancers/gastric/"},{"id":"locally-advanced-pdac","kind":"cancer","name":"Locally advanced unresectable pancreatic ductal adenocarcinoma","route":"/cancers/locally-advanced-pdac/"},{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"metastatic-pdac","kind":"cancer","name":"Metastatic pancreatic ductal adenocarcinoma","route":"/cancers/metastatic-pdac/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"pancreatoblastoma","kind":"cancer","name":"Pancreatoblastoma","route":"/cancers/pancreatoblastoma/"},{"id":"sclc","kind":"cancer","name":"Small-cell lung cancer","route":"/cancers/sclc/"}],"technology":[{"id":"cachexia-appetite-pharmacotherapy","kind":"technology","name":"Cachexia pharmacotherapy: GDF-15 blockade, anamorelin, olanzapine","route":"/technologies/cachexia-appetite-pharmacotherapy/"},{"id":"cachexia-therapy","kind":"technology","name":"Cachexia-directed therapy (GDF-15 blockade)","route":"/technologies/cachexia-therapy/"},{"id":"ct-body-composition-sarcopenia","kind":"technology","name":"CT body composition and sarcopenia measurement","route":"/technologies/ct-body-composition-sarcopenia/"},{"id":"omega3-epa-cachexia","kind":"technology","name":"Fish oil (EPA) for cancer weight loss","route":"/technologies/omega3-epa-cachexia/"},{"id":"hydrazine-sulfate","kind":"technology","name":"Hydrazine sulfate","route":"/technologies/hydrazine-sulfate/"},{"id":"rejuv-measure-body-composition","kind":"technology","name":"Measuring muscle and fat on scans the patient already had","route":"/technologies/rejuv-measure-body-composition/"},{"id":"muscle-recovery-after-cancer-treatment","kind":"technology","name":"Muscle and strength after treatment: sarcopenia, cachexia and what rebuilds","route":"/technologies/muscle-recovery-after-cancer-treatment/"},{"id":"oncology-nutrition","kind":"technology","name":"Nutrition support and cachexia management","route":"/technologies/oncology-nutrition/"},{"id":"nutrition-screening-mnt","kind":"technology","name":"Oncology nutrition assessment and medical nutrition therapy","route":"/technologies/nutrition-screening-mnt/"},{"id":"resistance-training-cachexia","kind":"technology","name":"Resistance training and protein for cachexia and sarcopenia","route":"/technologies/resistance-training-cachexia/"}],"pathway":[{"id":"cachexia-biology","kind":"pathway","name":"Cancer cachexia","route":"/pathways/cachexia-biology/"}],"term":[{"id":"body-composition","kind":"term","name":"Body composition (lean mass, fat mass, visceral fat)","route":"/terms/body-composition/"},{"id":"cytokine","kind":"term","name":"Cytokine","route":"/terms/cytokine/"},{"id":"malnutrition-screening","kind":"term","name":"Malnutrition screening tools (MUST, NRS-2002, MST, PG-SGA)","route":"/terms/malnutrition-screening/"},{"id":"nutrition-impact-symptoms","kind":"term","name":"Nutrition impact symptoms","route":"/terms/nutrition-impact-symptoms/"},{"id":"lung-palliation-breathlessness-effusion-obstruction","kind":"term","name":"Palliation in lung cancer: breathlessness, pleural effusion, blocked airway, bone and brain","route":"/terms/lung-palliation-breathlessness-effusion-obstruction/"},{"id":"pancreatic-palliation-obstruction-pain-nutrition","kind":"term","name":"Palliation in pancreatic cancer: biliary and duodenal stents, coeliac plexus block, enzymes and cachexia","route":"/terms/pancreatic-palliation-obstruction-pain-nutrition/"},{"id":"pancreatic-enzyme-replacement","kind":"term","name":"Pancreatic enzyme replacement therapy (PERT, pancreatin, Creon) for pancreatic exocrine insufficiency: why and how to take it","route":"/terms/pancreatic-enzyme-replacement/"},{"id":"performance-status","kind":"term","name":"Performance status (ECOG, Karnofsky)","route":"/terms/performance-status/"},{"id":"sarcopenia","kind":"term","name":"Sarcopenia","route":"/terms/sarcopenia/"},{"id":"gallbladder-cancer-symptom-control","kind":"term","name":"Symptom control in advanced gallbladder cancer: pain, ascites and nutrition","route":"/terms/gallbladder-cancer-symptom-control/"},{"id":"weight-loss-and-fat-digestion-biliary","kind":"term","name":"Weight loss, fat digestion and enzymes with gallbladder cancer","route":"/terms/weight-loss-and-fat-digestion-biliary/"}],"bottleneck":[{"id":"b-cachexia-supportive","kind":"bottleneck","name":"Cachexia, toxicity and the limits of the patient","route":"/bottlenecks/b-cachexia-supportive/"}],"paper":[{"id":"paper-fearon-lancet-oncol","kind":"paper","name":"Definition and classification of cancer cachexia: an international consensus","route":"/key-papers/paper-fearon-lancet-oncol/"}],"journal":[{"id":"journal-of-cachexia-sarcopenia-and-muscle","kind":"journal","name":"Journal of cachexia, sarcopenia and muscle","route":"/journals/journal-of-cachexia-sarcopenia-and-muscle/"}],"drug":[{"id":"pancrelipase","kind":"drug","name":"Pancrelipase (pancreatic enzyme replacement therapy)","route":"/drugs/pancrelipase/"}],"trial":[{"id":"nct06989437","kind":"trial","name":"A Study to Learn About the Medicine Ponsegromab in Adults With Cancer of the Pancreas Which Has Spread and Caused Significant Body Weight Loss and Fatigue","route":"/trials/nct06989437/"},{"id":"olanzapine-appetite-tmh","kind":"trial","name":"Low-dose olanzapine for cancer anorexia (Tata Memorial)","route":"/trials/olanzapine-appetite-tmh/"},{"id":"ponsegromab-phase-2","kind":"trial","name":"Ponsegromab phase 2 in cancer cachexia","route":"/trials/ponsegromab-phase-2/"},{"id":"romana-1-2","kind":"trial","name":"ROMANA 1 and ROMANA 2","route":"/trials/romana-1-2/"}],"idea":[{"id":"idea-nl-dietitian-in-every-mdt","kind":"idea","name":"A dietitian in every gastrointestinal and head and neck tumour board","route":"/ideas/idea-nl-dietitian-in-every-mdt/"}],"roadmap":[{"id":"nutrition-lifestyle-roadmap","kind":"roadmap","name":"Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment","route":"/roadmaps/nutrition-lifestyle-roadmap/"}]}}