|
| Agent | Clinical effect (RCT)# | Hypothetical mechanism of action |
|
| Anabolic agents | Corticosteroids | Improves anorexia and weakness; no improvement in weight or calorie intake [23–25]; well tolerated; effects short lasting | Not established. May inhibit prostaglandin metabolism and central euphoric effect |
|
| Nandrolone decanoate | Decrease in weight loss [26] | Not established. Promote protein nitrogen accumulation |
|
| Oxandrolone | No published randomised clinical trials in cancer cohort | Not established |
|
| Insulin | Increases whole body fat and carbohydrate intake [27] | Not established |
|
| Adenosine Triphosphate (ATP) | Stabilises weight loss and increases energy intake[28] | Not established |
|
| Appetite stimulants | Progesterones: Megestrol acetate (MA) Medroxyprogesterone (MP) | Improves appetite, calorie intake and weight (not lean body mass) [29] | MA: may increase the central appetite stimulant neuropeptide YMP: reduces serotonin and cytokine production by PBMCs [30] |
|
| Cannabinoids: Dronabinol | No benefit when added to MA; inferior to MA when used alone [31]. No increase in appetite or QoL [32] | May act on endorphin receptors, reduce prostaglandin synthesis or inhibit IL-1 secretion [33] |
|
| Cytokine inhibitors | Cyproheptadine | No improvement in weight gain [34] | Serotonin antagonist with antihistaminic properties |
|
| Thalidomide | Attenuates weight loss, increases lean body mass [35] | Immunomodulatory: downregulates TNF-α (by destabilising mRNA [36]), NFκB, pro-inflammatory cytokines, COX2 [37] |
|
| Pentoxifylline | No improvement in appetite or weight in cachectic patients [38] | Phosphodiesterase inhibitor: inhibits TNF gene transcription |
|
| Eicosapentaenoic acid (EPA) | Cochrane meta-analysis: insufficient evidence to establish whether EPA is better than placebo [39] | In vitro attenuates increased cAMP activity and lipolysis by LMF [40] |
|
| Melatonin | Improves cachexia (term not defined) and one year survival increased in advanced NCSC lung cancer [41] | Immunomodulatory [42], Downregulates TNF production [43] |
|
| Anti-inflammatories | Non-steroid anti-inflammatory drugs | Reduced inflammatory markers, reduced resting energy expenditure, preservation of total body fat [44] | Not established. May downregulate systemic inflammatory response to tumour |
|
