Title:Understanding Immunomodulation and Managing Cancer Cachexia: A Narrative Review
Volume: 11
Author(s): Lingbing Zhang*Xun Zhu
Affiliation:
- Department of Cancer Research, Yinuoke Ltd., Changchun, 130012, China
Keywords:
Cachexia, cancer, immunomodulation, homeostasis, anorexia, metabolism.
Abstract: Cancer cachexia is a complex, multifactorial syndrome commonly seen in patients
with advanced cancer. Characterized by progressive weight loss, muscle and fat wasting, systemic
inflammation, and impaired immune responses, cachexia involves a dysregulated host-tumor
interaction that alters metabolism and disrupts immune homeostasis. Unlike malnutrition, cancer
cachexia significantly affects the quality of life (QoL), treatment response, and overall survival.
Despite its clinical relevance, particularly in cancers such as pancreatic, lung, liver, and gastrointestinal
malignancies, there is a lack of standardized, effective treatments, and the immunological
mechanisms underlying cachexia are not yet fully understood. Therefore, a better understanding
of not just the pathways but also the underlying factors that influence the occurrence of cancer
cachexia is vital to develop targeted therapeutic strategies. This review aims to explore the pathophysiology
of cancer cachexia and also highlight a few key factors influencing cachexia occurrence,
such as age, gender, comorbidities, cancer type, and stage. It also evaluates current and
emerging therapeutic approaches, potential immunomodulatory strategies, and identifies the gaps
in research and proposes future directions for the personalized management of cancer cachexia.
Therapeutic strategies such as exercise, nutritional support, ghrelin agonists, myostatin inhibitors,
and anti-inflammatory agents offer partial benefits. Promising immunomodulatory approaches,
including agents like R-ketorolac and gut microbiota-targeted therapies, demonstrate
potential in some clinical studies. However, cancer cachexia necessitates a multimodal treatment
framework incorporating immunological insights and integrating physical activity and nutritional
support along with pharmacological intervention, personalized as per the patients’ needs.
