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Alessandro Laviano
Cancer patient treatment journey
Dubai Nutrition Conference(Dubai, UAE, 24-26 October 2018)
Disclosures
• Consulting Fees: Abbott, Baxter, BASF, Nestlè Health Science, Nutricia Advanced Medical Nutrition, Nutrileads, Smartfish
• Grants: Fresenius-Kabi (INFORM trial)
• Independent lectures at industry-organized symposia: Abbott, BBraun, Fresenius-Kabi, Nestlè Health Science, Nutricia Advanced Medical Nutrition, Smartfish
Bray F et al. CA Cancer J Clin 2018
Bray F et al. CA Cancer J Clin 2018
Cancer is a systemic disease, or how cancer can kill
Patel JD et al. Ann Oncol 2016; 27:1612-1619
Fig. 2. Diagnoses tree of malnutrition; from at risk for malnutrition, basic definition of malnutrition to aetiology-based diagnoses
T. Cederholm, R. Barazzoni, P. Austin, P. Ballmer, G. Biolo, S.C. Bischoff, C. Compher, I. Correia, T. Higashiguchi, M. Holst, G.L. Jensen, A. Malone, M. Muscaritoli, I. Nyulasi, M. Pirlich, E. Rothenberg, K. Schindler...
ESPEN guidelines on definitions and terminology of clinical nutrition
Clinical Nutrition, Volume 36, Issue 1, 2017, 49–64
http://dx.doi.org/10.1016/j.clnu.2016.09.004
Martin L et al. Ann Surg Oncol 2018
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Cancer cachexia: neglected, overlooked, disregarded
• Cachexia is a paraneoplastic syndrome
• Association vs causation (i.e., link between cachexia andoutcome)
• Koch’s postulates
• Nutrition feeds the tumor
• Reliably measuring body composition
Cespedes Feliciano E.M. et al. Cancer 2017; 123:4868-4877
Kovic B et al. JAMA Int Med 2018
Cancer cachexia: neglected, overlooked, disregarded
Cachexia• is a paraneoplastic syndrome
Association• vs causation (i.e., pathophysiologic link betweencachexia and outcome)
Koch• ’s postulates
Nutrition• feeds the tumor
Reliably• measuring body composition
Clin Cancer Res 2007
Coss CC et al. Clin Cancer Res 2018
Cancer cachexia: neglected, overlooked, disregarded
• Cachexia is a paraneoplastic syndrome
• Association vs causation (i.e., pathophysiologic link betweencachexia and outcome)
• Koch’s postulates
• Nutrition feeds the tumor
• Reliably measuring body composition
ESPEN Guidelines (Arends J et al. Clin Nutr 2017) recommend:a. 25-30 Kcal/KgBW/day (strength: STRONG; level: low)b. 1-1.5 g/KgBW/day (strength: STRONG; level: moderate)
Baracos VE et al. Nat Rev Dis Primer 2018; 4:17105Stobaus N et al. Nutr Cancer 2015
adapted from Laviano A et al. Proc Nutr Soc 2018
chronic intervention:- preserve body weight- diet quality- physical activity
acute intervention:- preserve body weight- patient tailored- counselling- ONS- EN- PN
Van Blarigan EL et al. JAMA Oncol 2018
Trestini I et al. Eur J Clin Nutr 2018
Cancer cachexia: neglected, overlooked, disregarded
• Cachexia is a paraneoplastic syndrome
• Association vs causation (i.e., pathophysiologic link betweencachexia and outcome)
• Koch’s postulates
• Nutrition feeds the tumor
• Reliably measuring body composition
Deshayes E et al. Clin Nutr 2018
Cancer cachexia: neglected, overlooked, disregarded
• Cachexia is a paraneoplastic syndrome
• Association vs causation (i.e., pathophysiologic link betweencachexia and outcome)
• Koch’s postulates
• Nutrition feeds the tumor
• Reliably measuring body composition
Cespedes Feliciano EM et al. J Cachexia Sarcopenia Muscle 2018
Rauh S et al. ESMO Open 2018
J Clin Oncol 2017; 35:96-112
«For newly diagnosed patients with advanced cancer, theExpert Panel suggests early palliative involvement within 8weeks of diagnosis (type: informal consensus, benefitsoutweigh harms, evidence quality: intermediate; strength ofrecommendation: moderate)»
Baldwin C et al. Eur J Cancer 2006; 42:2504-2509
Cong M-H et al. Chinese Medical Jorunal 2015
ConclusionsCancer cachexia is a frequent and clinically relevant paraneoplastic syndrome, affecting patients’ quality of life and outcome.
Anticancer therapies contribute to nutritional wasting, further limiting patients’ tolerance to treatments.
Emerging clinical data show that closing the nutritional gap early duringanticancer treatment prevents further weight and muscle loss, and allowscompletion of scheduled therapies.
The use of specific nutrients appears to potentiate the metabolic effects of meeting energy and protein requirements.
Thank you.
