[The effect of blocking TNF-alpha in patients with cancer-related cachexia and anorexia].

Abstract Cancer-related cachexia and anorexia are present in more than 80% of patients with malignancies. The pathophysiology is not fully known and during the past several years major attention was attributed to the function of secreted cytokines, such as TNF-alpha, as a fundamental part of the process. In the attempt to prevent the weight loss, which in many cases causes the patients' death, many studies have been conducted where the effect of the cytokine TNF-alpha was blocked. This article presents two different studies from the past several years where the effect was inhibited by two different methods: one by the monoclonal antibody Infliximab and the other by blocking the TNF-alpha receptor with Etanercept. Both were double-blinded and the patients were randomly divided into arms, with the control group treated with placebo. In both groups, primary and secondary outcomes were defined, however, in the end, no statistical significance was achieved. In conclusion, cancer-related cachexia and anorexia are not the result of one cytokine by itself and blocking it causes only a minimal change without any statistical significance in cancer patients. It is reasonable to assume that the body adaptation to the tumor, which results in cachexia, is due to several mediators working together rather than a single major mediator.