CROATIAN GUIDELINESS FOR USE OF EICOSAPENTAENOIC ACID AND MEGESTROL ACETATE IN CANCER CACHEXIA SYNDROME
Autori:
Željko Krznarić, Antonio Juretić, Mirko Šamija, Renata Dobrila Dintinjana, Eduard Vrdoljak, Miroslav Samaržija, Sanja Kolaček, Damir Vrbanec, Drago Prgomet, Mirko Ivkić, Marko Zelić
Sažetak
Sažetak. Kod velikog broja onkoloških bolesnika već pri postavljanju dijagnoze uočavamo značajan gubitak tjelesne mase, masnog tkiva, a osobito proteina uz naglašenu upalnu aktivnost. Takvo tjelesno propadanje u onkoloških bolesnika nazivamo sindromom tumorske kaheksije, uz često prisutnu anoreksiju. Tumorska kaheksija značajno utječe na proces liječenja bolesnika i stopu preživljenja. Standardnom nutritivnom potporom nije moguće zaustaviti tjelesno propadanje u sindromu tumorske anoreksije i kaheksije. U segmentu kliničke prehrane unatrag nekoliko godina osobito se propituje svrhovitost primjene eikozapentaenske kiseline (EPA) i megestrol-acetata (MA) u liječenju onkoloških bolesnika. Radna skupina koju su činili stručnjaci iz različitih područja kliničke medicine sastavila je Hrvatske smjernice za primjenu eikozapentaenske kiseline i megestrol-acetata u liječenju tumorske kaheksije. Izrada smjernica temelji se na dokazima iz relevantne medicinske literature. Zaključeno je da je primjena megestrol-acetata i enteralne prehrane s povišenim unosom eikozapentaenske kiseline u trajanju od 8 tjedana poželjna terapijska kombinacija u bolesnika s izraženom tumorskom anoreksijom i kaheksijom.
Summary
Summary. Among many oncological patients we can notice a substantial loss of body weight, fat and proteins with significant proinflammatory activity at the time of diagnosis. This wasting condition is well known as cancer cachexia syndrome. Anorexia is important part of this syndrome. Because cancer cachexia reduces tumor response to treatment and it is an indicator of poor prognosis, we need to start correcting these nutritional deficits at once. In the presence of cancer cachexia it is extremely difficult to achieve protein anabolism and stop the body wasting by standard nutritional formulas only. During the last few years, the use of eicosapentaenoic acid (EPA) and megestrol acetate (MA) as anticahectic agents has been tested. These guidelines are intended to give evidence-based recommendations for the use of eicosapentaenoic acid and megestrol acetate in cancer cachexia syndrome. These guidelines have been developed by interdisciplinary expert group of Croatian clinicians. Based on relevant literature, we have concluded that the use of metabolic modulators such as eicosapentaenoic acid and megestrol acetate for 8 weeks may help to improve nutritional status in cachectic patients.
