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GASTROINTESTINAL (NONCOLORECTAL) CANCER Nutritional Support in Gastrointestinal Malignancies CHAIR Vincent J. Picozzi, MD Virginia Mason Medical Center Seattle, WA SPEAKERS Maria Q.B. Petzel, RD, CSO The University of Texas MD Anderson Cancer Center Houston, TX Egidio Del Fabbro, MD Virginia Commonwealth University Richmond, VA
ASSESSMENT AND TREATMENT OF CACS Current and Future Care of Patients with the Cancer Anorexia- Cachexia Syndrome Egidio Del Fabbro, MD OVERVIEW Many important advances have occurred in the field of cancer cachexia over the past decade, including progress in understanding the mechanisms of the cancer anorexia-cachexia syndrome (CACS) and the development of promising pharmacologic and supportive care interventions. However, no approved agents for cancer cachexia currently exist, emphasizing the unmet need for an effective pharmacologic therapy. This article reviews the key elements of CACS assessment in daily practice, the contribution of nutritional impact symptoms (NIS), the evidence for current pharmacologic options, and promising anticachexia agents in perclinical and clinical trials. It also proposes a model for multimodality therapy and highlights issues pertinent to CACS in patients with pancreatic, gastric, and esophageal cancer. Many important advances have occurred in the fıeld of cancer cachexia over the past decade, including progress in understanding the mechanisms of CACS and the development of promising pharmacologic and supportive care interventions. However, no approved agents for cancer cachexia currently exist, emphasizing the unmet need for an effective pharmacologic therapy. Patients with CACS may have different priorities; for many, preserving lean body mass (LBM) and function may be important, while for others, maintaining appetite to enjoy meals with their family may be the primary goal. Appetite and weight loss are also associated with important clinical outcomes such as decreased survival, fewer completed cycles of chemotherapy, more treatment side effects, and poorer health-related quality of life. 1-3 CACHEXIA AND UPPER GASTROINTESTINAL CANCERS A study by DeWys 4 in 1980, of more than 3,000 patients enrolled in Eastern Cooperative Oncology Group chemotherapy trials, identifıed the high prevalence of weight loss in cancer and its association with decreased survival. The survival of patients with gastric and pancreatic cancer did not correlate with weight loss (even though 85% of these patients experienced weight loss, and one-third lost more than 10%). Possibly, weight loss may have lost its powerful predictive value in these patients because of their very poor prognosis. 5 A subsequent retrospective study found weight loss in pancreatic and gastric cancer at presentation was associated with poorer quality of life and increased chemotherapy toxicity, even at lower doses. 6 Outpatients with esophageal or pancreatic cancer have the highest nutritional risk scores, and more than 80% experience anorexia and weight loss even when they have a performance status (PS) of 1. 7 ASSESSMENT OF PATIENTS A consensus defınition of cancer cachexia is important for clinical trial design and for identifying patients with the syndrome in clinical practice. Ideally, patients who are at risk should be identifıed early to provide the greatest opportunity for effective intervention. A delay could result in uncontrolled symptoms, poorer quality of life, and more rapid entry into the refractory stage of cachexia. A recent study of body composition imaging by CT of 368 patients shows 5% or less of patients gained muscle within 90 days of death, suggesting the anabolic opportunity for intervention probably exists early in the disease trajectory. 8 Definition Cancer cachexia is defıned as a multifactorial syndrome characterized by ongoing loss of skeletal muscle mass (with or without loss of fat) leading to progressive functional impairment, which cannot be fully reversed by conventional nutritional support. 9 Based on the current defınition, detection of cancer cachexia centers on involuntary weight loss of more than 5% over 6 months (or 2% when evidence of sarcopenia is present). 9,10 Recently, attempts have been made to incorporate anorexia severity, PS, and markers of inflammation, such as C-reactive protein, into staging criteria for the identifıca- From the Palliative Care Program, Virginia Commonwealth University, Richmond, VA. Disclosures of potential conflicts of interest are found at the end of this article. Corresponding author: Egidio del Fabbro, MD, Virginia Commonwealth University, 1101 E. Marshall St., Richmond, VA 23298; email: edelfabbro@vcu.edu. © 2015 by American Society of Clinical Oncology. asco.org/edbook | 2015 ASCO EDUCATIONAL BOOK e229
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AMERICAN SOCIETY OF CLINICAL ONCOLO
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Controversies in Neoadjuvant Therap
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Managing Ovarian Cancer in the Olde
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Updates in the Multimodality Manage
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PEDIATRIC ONCOLOGY Real-Time Molecu
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2015 ASCO Annual Meeting Disclosure
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2015 Educational Book Expert Panel
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James Marshall, PhD Roswell Park Ca
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2015 Annual Meeting Supporters* MIS
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David Yurman Corporate Allies Conqu
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MICHAEL A. POSTOW Managing Immune C
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GYNECOLOGIC CANCER Cervical Cancer
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GYNECOLOGIC CANCER Managing Ovarian
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GYNECOLOGIC CANCER Treatment of the
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HEALTH SERVICES RESEARCH AND QUALIT
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INDUSTRY AND ONCOLOGY KEY POINTS F
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INDUSTRY AND ONCOLOGY by (covered)
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CANCER CARE QUALITY: CURRENT STATE
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MANAGING OLDER PATIENTS WITH ALL Th
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TREATMENT OF PHILADELPHIA CHROMOSOM
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CD19 CAR THERAPY FOR ALL FIGURE 1.
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NEW TARGETED THERAPIES FOR iNHL New
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PEMMARAJU AND MOLITERNO drome (BCS)
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GERBER, PAIK, AND DOWLATI gression
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LUNG CANCER Updates in the Multimod
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NASSER HANNA Current Standards and
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NASSER HANNA culty of this task. Va
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LYMPHOMA AND PLASMA CELL DISORDERS
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NOWAKOWSKI AND CZUCZMAN sociated wi
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MANAGEMENT OF CLL Up-Front Manageme
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MANAGEMENT OF CLL than 17p-/TP53mut
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MANAGEMENT OF CLL could be associat
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MANAGEMENT OF CLL tion by nonmalign
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MANAGEMENT OF CLL lymphocytic leuke
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MERKEL CELL CARCINOMA Merkel Cell C
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MERKEL CELL CARCINOMA tions in PIK3
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PERFUSION AND INFUSION IN THE ERA O
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SULLIVAN ET AL FIGURE 1. Relevant S
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SULLIVAN ET AL 17. Halait H, Demart
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SULLIVAN ET AL NRAS-mutant melanoma
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KLEPIN, RODIN, AND HURRIA Treating
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KLEPIN, RODIN, AND HURRIA plication
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PERIPHERAL NEUROTOXICITY IN CANCER
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PARTRIDGE, JACOBSEN, AND ANDERSEN c
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PARTRIDGE, JACOBSEN, AND ANDERSEN w
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PARTRIDGE, JACOBSEN, AND ANDERSEN v
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LESLIE R. SCHOVER Sexual Healing in
Page 782 and 783:
LESLIE R. SCHOVER tinuous ADT in pr
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LESLIE R. SCHOVER 12. Potosky AL, H
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CATHERINE H. VAN POZNAK TABLE 1. Wo
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CATHERINE H. VAN POZNAK (tamoxifen,
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CATHERINE H. VAN POZNAK TABLE 3. FD
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CATHERINE H. VAN POZNAK premenopaus
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SHARI GOLDFARB KEY POINTS Brea
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SHARI GOLDFARB and friction with va
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SHARI GOLDFARB importance both duri
Page 800 and 801:
PATIENT AND SURVIVOR CARE Moving Su
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MAYER ET AL TABLE 1. Quality Metric
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MAYER ET AL to enhance the quality
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MAYER ET AL FIGURE 2. (A) Infertili
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MAYER ET AL efıcial suggests that
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PATIENT AND SURVIVOR CARE The Chall
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BRUERA AND PAICE Choice of Opioid a
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BRUERA AND PAICE toxicity and proce
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BRUERA AND PAICE effective. Basic s
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PEDIATRIC ONCOLOGY Real-Time Molecu
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CARROLL, RAETZ, AND MEYER KEY POINT
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CARROLL, RAETZ, AND MEYER most are
Page 824 and 825:
CARROLL, RAETZ, AND MEYER markers a
Page 826 and 827:
PEDIATRIC ONCOLOGY Translating Surv
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REDUCING THE BURDEN OF LATE EFFECTS
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Page 832 and 833:
Page 834 and 835:
Page 836 and 837:
PROFESSIONAL DEVELOPMENT The Challe
Page 838 and 839:
ADVANCES IN WEBSITE INFORMATION RES
Page 840 and 841:
Page 842 and 843:
Page 844 and 845:
Page 846 and 847:
COMMUNICATION AND TECHNOLOGY: IT’
Page 848 and 849:
Page 850 and 851:
Page 852 and 853:
PATIENT-REPORTED OUTCOMES IN ONCOLO
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PATIENT-REPORTED OUTCOMES IN ONCOLO
Page 856 and 857:
PROFESSIONAL DEVELOPMENT Trends, An
Page 858 and 859:
CLINICAL ONCOLOGY PRACTICE 2015 FIG
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CLINICAL ONCOLOGY PRACTICE 2015 (6.
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CLINICAL ONCOLOGY PRACTICE 2015 Pro
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ADJUVANT/NEOADJUVANT MEDICAL THERAP
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Page 868 and 869:
Page 870 and 871:
INDICATIONS FOR ADJUVANT RADIATION
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Page 874 and 875:
Page 876 and 877:
Page 878 and 879:
SARCOMA Latest Advances in Systemic
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SYSTEMIC THERAPY FOR OSTEOSARCOMA A
Page 882 and 883:
SYSTEMIC THERAPY FOR OSTEOSARCOMA A
Page 884 and 885:
RETHINKING TREATMENT FOR CHONDROSAR
Page 886 and 887:
Page 888 and 889:
Page 890 and 891:
Page 892 and 893:
BONE SARCOMAS IN ADULTS local disea
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BONE SARCOMAS IN ADULTS structure a
Page 896 and 897:
SARCOMA Well-Differentiated and Ded
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ABBAS MANJI ET AL ticular region. 7
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ABBAS MANJI ET AL MYXOID (ROUND CEL
Page 902 and 903:
ABBAS MANJI ET AL versus doxorubici
Page 904 and 905:
SHLUSH AND HERSHKOVITZ Clonal Evolu
Page 906 and 907:
SHLUSH AND HERSHKOVITZ FIGURE 1. Ti
Page 908 and 909:
TUMOR BIOLOGY New Strategies to Und
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KNAPP, DHAWAN, AND OSTRANDER in dog
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KNAPP, DHAWAN, AND OSTRANDER TABLE
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KNAPP, DHAWAN, AND OSTRANDER 14. Fe
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SOURBIER, SRINIVASAN, AND LINEHAN M
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SOURBIER, SRINIVASAN, AND LINEHAN F
Page 920 and 921:
SOURBIER, SRINIVASAN, AND LINEHAN T
Page 922:
Author Index Abbas Manji, Gulam ...
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