Sarcopenia and chemotherapy-mediated toxicity / Sarcopenia e toxicidade mediada pela quimioterapia

ABSTRACT This narrative review focuses on the role of sarcopenia and chemotherapy-induced toxicity in cancer patients. Consistent evidence shows that sarcopenia in cancer patients leads to decreased overall survival by influencing treatment discontinuation and dose reduction. Therefore, sarcopenia should be considered a robust prognostic factor of negative outcome as well as a determinant of increased healthcare costs.

RESUMO Esta revisão narrativa descreve o papel da sarcopenia e a toxicidade mediada pela quimioterapia em pacientes com câncer. Diversas evidências consistentes mostram que a sarcopenia em pacientes com câncer induz à menor sobrevida global, por influenciar na interrupção do tratamento e na redução da dose. Portanto, a sarcopenia pode ser considerada um importante fator de prognóstico de desfecho negativo, além de um determinante de maiores custos em saúde.

Patogenia, clínica y tratamiento del síndrome de anorexia-caquexia asociado al cáncer / Cancer-associated anorexia-cachexia syndrome: pathogenesis, clinical features and therapeutic approaches

Anorexia-cachexia syndrome is highly prevalent among cancer patients, it impacts on morbidity and mortality, and impinges on quality of life. Anorexia is defined as the loss of the desire to, while cachexia defines the progressive wasting of skeletal muscle mass and adipose tissue. The pathogenesis of anorexia-cachexia is multifactorial, but tumour-derived factors and cytokines appear to play a significant role, representing a suitable therapeutic target. In muscles, increased proteolysis and reduced protein synthesis yield to skeletal muscle wasting. Increased lipolysis and depressed lipogenesis result in adipose tissues wasting. Neurochemical perturbations appear to represent the pathogenic mechanism of anorexia and reduced food intake. Cancer anorexia-cachexia syndrome should be therapeutically approached by targeting the pathogenic mechanisms. Thus, the optimal therapeutic approach should be aimed at counteracting both changes in dietary habits and tumour-related metabolic perturbations

El síndrome de anorexia-caquexia es muy prevalente en los pacientes con cáncer, repercute sobre la morbimortalidad y altera la calidad de vida. La anorexia se define como la pérdida del deseo de comer; mientras que se considera caquexia la consumición progresiva de la masa muscular esquelética y del tejido adiposo. La patogénesis del síndrome de anorexia-caquexia es multifactorial, pero los factores tumorales y las citoquinas parecen cumplir un papel significativo y representan un objetivo terapéutico adecuado. En los músculos, el incremento de la proteólisis y la disminución de la síntesis de proteínas llevan al deterioro muscular esquelético; mientras que el aumento de la lipólisis y la disminución de la lipogénesis producen la consunción del tejido adiposo. Las alteraciones neuroquímicas parecen representar el mecanismo patogénico de la anorexia y de la reducción de la ingesta alimentaria. El enfoque terapéutico del síndrome de anorexia-caquexia asociado al cáncer debe centrarse en los mecanismos patogénicos. De este modo, la estrategia terapéutica óptima debe dirigirse a contrarrestar los cambios en los hábitos alimentarios y las alteraciones metabólicas relacionadas con el tumo