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Cancer cachexia, the muscle and fat wasting driven by tumour and host inflammatory signals, affects most patients with advanced pancreatic, gastric and lung cancer, and treatment-limiting toxicities decide what dose a patient can receive. Only Japan has an approved cachexia drug, and supportive care research gets a small share of funding relative to its effect.
Cancer cachexia, a syndrome of muscle and fat loss driven by tumour-derived and host inflammatory signals (IL-6, GDF15, activin), affects most patients with advanced pancreatic, gastric and lung cancer and is implicated in a large share of cancer deaths, yet anamorelin in Japan is the only approved drug anywhere and there is none in the US or Europe. Beyond cachexia, treatment-limiting toxicities determine what dose a patient can receive: neuropathy, cardiotoxicity, cytopenias, interstitial lung disease from ADCs, cytokine release and neurotoxicity from cell therapies, and fatigue. Supportive-care research receives a small share of funding relative to its effect on survival and quality of life, and effective interventions such as structured exercise and geriatric assessment are rarely prescribed. Treating the host is a therapeutic target in its own right.
A low dose of an old, inexpensive tablet improved appetite and weight in a randomised trial of people with advanced cancer. It could be used almost everywhere tomorrow.
Wasting and side-effects kill or stop treatment for a large share of patients but attract almost no dedicated funding. This would create a standing programme for them.
Malnutrition is the commonest untreated complication in cancers of the gut, throat and pancreas. Putting a dietitian in the meeting where treatment is decided means it is seen and treated before chemotherapy starts, not after weight has been lost.
For symptoms such as nausea, fatigue or neuropathy, each patient can alternate the drug and a placebo over several periods and learn what works for them. Pooling these single-patient crossover trials with Bayesian models also gives a population answer, in areas where conventional trials are rare.
A supportive-care ARPA would be a well-funded, milestone-driven agency that develops drugs for nausea, nerve damage, mouth sores, fatigue and brain fog from cancer treatment, which the market has largely ignored.
Slow weight loss and falling daily activity are the first signs of cancer wasting, and both can be measured at home. An alert could bring help months earlier.
A new antibody blocks the hormone that makes people with cancer lose appetite and weight. Weight regained as muscle, not fat, needs exercise and protein alongside it.
A randomised placebo-controlled trial at Tata Memorial found that 2.5 mg of olanzapine daily, a cheap antipsychotic pill already used for chemotherapy nausea, improved appetite and weight gain in patients starting chemotherapy for advanced stomach, lung and hepatopancreatobiliary cancers. A multinational confirmatory trial is needed before guidelines and labels adopt it.
Chemotherapy doses are calculated from height and weight, a formula from the 1950s. Doses based on actual muscle mass may cause fewer severe side-effects.
Most people with pancreatic cancer lose muscle and weight in a way food alone cannot reverse, and that wasting is a common reason chemotherapy is cut or stopped. A 2024 trial showed an antibody against the hormone GDF-15 restored weight and activity in twelve weeks, a third of the patients having pancreatic cancer. The proposal is to test it inside the chemotherapy trials, not alongside them.
Getting fitter and better nourished before an operation reduces complications and speeds recovery. It is cheap, but only a few hospitals do it.
A drug that improves appetite and lean weight in cancer wasting is approved in Japan but almost nowhere else. Reviewing the existing evidence could widen access quickly.
The pancreas makes the enzymes that digest food, and a cancer in it, or the operation to remove it, leaves most patients unable to absorb what they eat. Capsules replacing those enzymes are cheap and recommended, yet UK records show only one patient in five was prescribed them. The proposal is to prescribe by default at diagnosis, publish each hospital's rate, and run the trial never done.
A large trial showed a structured exercise programme improved survival after bowel cancer. Almost no health system pays for it, so almost no patient gets it.
Regulators are unsure what to accept as proof that an anti-wasting drug helps. Agreeing on a simple measure such as stair climbing would unblock the whole field.
Every staging scan contains a precise measure of muscle mass that nobody looks at. Software could report it automatically and flag patients heading for wasting.
Wasting has several causes. Measuring the specific hormone in each patient's blood would put the right patients into the right trial instead of mixing everyone together.
Muscle is an immune organ as well as a movement organ. Building it during immunotherapy might improve how well the treatment works, not just how patients feel.
The wasting that kills many cancer patients has had no effective drug. New antibodies against GDF-15 restored weight in early trials. Combine them with exercise and nutrition and test properly.
Hospitals have fast, standard responses to sepsis and heart attacks. Cancer wasting has no such pathway, so it is noticed late and treated inconsistently.
The first drug to reverse cancer cachexia mechanistically rather than by appetite stimulation, in a disease where weight loss stops chemotherapy being delivered; the phase 3 programme and the question of survival remain.
One technology page and one bottleneck page on OnCo cite this paper by its DOI; this record gives the citation a page of its own so a reader can follow it without leaving OnCo. Read the abstract above alongside the citing pages listed under Related; the record was created automatically from the Europe PMC entry and its figures have not been checked by hand.
Enzyme replacement is cheap, guideline-recommended (NICE NG85) and under-prescribed; the National Pancreatic Cancer Audit now reports the prescribing rate as a performance indicator, which the UK and NHS page tracks.
One term page, one bottleneck page and eleven idea pages on OnCo cite this paper by its DOI; this record gives the citation a page of its own so a reader can follow it without leaving OnCo. Read the abstract above alongside the citing pages listed under Related; the record was created automatically from the Europe PMC entry and its figures have not been checked by hand.
Shares Fish oil (EPA) for cancer weight loss, ROMANA 1 and ROMANA 2, Ponsegromab phase 2 in cancer cachexia, Muscle and strength after treatment: sarcopenia, cachexia and what rebuilds.
Shares Fish oil (EPA) for cancer weight loss, Enteral and parenteral nutrition support, A dietitian in every gastrointestinal and head and neck tumour board, Measuring muscle and fat on scans the patient already had.
Shares Read muscle loss automatically from scans patients already have, ROMANA 1 and ROMANA 2, Ponsegromab phase 2 in cancer cachexia, Measuring muscle and fat on scans the patient already had.
Shares Measuring muscle and fat on scans the patient already had, Malnutrition screening tools (MUST, NRS-2002, MST, PG-SGA), Muscle and strength after treatment: sarcopenia, cachexia and what rebuilds, Sarcopenia.
Shares ROMANA 1 and ROMANA 2, Ponsegromab phase 2 in cancer cachexia, Resistance training and protein for cachexia and sarcopenia, Cachexia pharmacotherapy: GDF-15 blockade, anamorelin, olanzapine.
Shares Measuring muscle and fat on scans the patient already had, Muscle and strength after treatment: sarcopenia, cachexia and what rebuilds, Sarcopenia, Geriatric assessment.
Shares Combine the new anti-wasting antibody with exercise and protein, Pay for supervised exercise the way we pay for drugs, Structured exercise prescribed like a drug in all curative-intent cancer care, Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards.
Shares Ponsegromab for the Treatment of Cancer Cachexia, Embed cachexia treatment in chemotherapy trials: weight, muscle and treatment delivery as co-primary endpoints, Pfizer (incl. Seagen), Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question.