Lung cancer anorexia

Altretamine has shown activity in the treatment of ovarian and lung cancer. This orally administered drug has the dose-limiting side effects of anorexia, nausea, vomiting, diarrhea, and abdominal cramping. Other side effects include neuropathy, agitation, confusion, and depression. 

In a phase II study of cetuximab and radiation in elderly and/or poor performance status patients with locally advanced non-small-cell lung cancer, there were no treatment-related deaths, but 31 patients had grade 3 or worse adverse events, most commonly/flf/gMe, anorexia, dyspnea, rashes, and dysphagia, each of which occurred in under 10% of patients [107 ]. 

The anorexia suffered by cancer patients is likely to arise from a combination of psychological stress, altered senses of taste and smell and increased levels of cytokines, which influence the appetite and satiety centres in the hypothalamus. There are several consequences micronutrient intake will be diminished and this may contribute to the signs and symptoms of the disease. Plasma amino acid levels will fall, as in starvation (Chapter 16). Synthesis of glutamine (by muscle, adipose and lung), aspartate (by liver), glutathione (by the intestine) and arginine (by the kidney) will all be compromised. The metabolic significance of all of these is discussed in Chapter 18. 

Limonene and perillic acid remarkably reduced the lung metatastatic tumour nodule formation by 65 and 67%, respectively however, perillyl alcohol was considerably more potent than limonene against breast cancer [284, 302], rat mammary cancer and pancreatic tumours [288]. Phase 1 studies of d-limo-nene [303, 304] and phase I and phase II [305-311] studies of perillyl alcohol revealed dose-limiting toxicities nausea, vomiting, anorexia, unpleasant taste and eructation, and thus a maximum tolerated dose for perillyl alcohol was determined [305]. 

Other studies have suggested that melatonin, a frequently used integrative medicine, can attenuate weight loss, anorexia and fatigue in patients with cancer. However, these studies were limited by a lack of blinding and absence of placebo controls. The prime purpose of this study was to compare melatonin with placebo for appetite improvement in patients with cancer cachexia. For this a randomised, double-blind, 28-day trial of melatonin 20 mg versus placebo in patients with advanced lung or GI cancer, appetite scores S 4 on a 0-10 scale (10=worst appetite), and history of weight loss S 5%, was performed [45 ]. 

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