Cancer-associated weight loss: releasing its firm grip on negative clinical outcomes
What does the future hold for treating weight loss in advanced cancer patients? The past 5 years have yielded immense disappointment in efforts to treat the cancer-associated weight loss syndrome. As reviewed by Garcia (pp. 266–271) in this issue of Current Opinions in Supportive and Palliative Care, two large registration trials, which, in total, included over 1500 patients and cost an estimated $100 million, failed to achieve their primary dual endpoints [1,2]. Neither of these trials – one which tested the selective androgen receptor modulator, enobosarm, and the other which tested the oral ghrelin mimetic, anamorelin – resulted in a prescribable agent, leading to the same stagnant conclusion that modest palliation with older agents, such as progesterones and corticosteroids, remains the only proven therapeutic approach for select weight-losing cancer patients with an incurable malignancy [3,4]. For example, in the anamorelin trials, it was an absence of improvement in hand grip strength that led to disappointment. In essence, over the past 4 decades, the standard of care for treating cancer-associated weight loss in incurable cancer patients remains unchanged. Hence, the question posed above is not only provocative but also relevant and timely.