Phase II study of high-dose fish oil capsules for patients with cancer-related cachexia

A Cancer and Leukemia Group B study

In their article, Burns et al. address the likely correlation existing in cancer patients between weight gain and improved quality of life.1 Similarly, Moses et al. demonstrated that cachectic cancer patients supplemented with fish oil increased their physical activity, which may reflect an improved quality of life.2 Therefore, it could be speculated that fish oil increases patients' body weight, particularly lean body mass or its function/ability, resulting in increased physical activity and thus an improved quality of life. However, the antidepressive effects of fish oil should not be overlooked. In cancer patients, depression is highly prevalent and fish oil, particularly eicosapentaenoic acid (EPA), may play an important role in the etiology of depression.3 Supporting this hypothesis, Suzuki et al. demonstrated that in patients with lung carcinoma, the daily total EPA intake appeared to be associated with the onset of depressive symptoms.4 In addition, ethyl-EPA when added to existing antidepressive medication has been reported to have a strong therapeutic effect.3 Therefore, it should be considered that in cachectic cancer patients responding to fish oil supplementation, at least part of the beneficial effects observed with regard to physical activity and quality of life could be secondary to the amelioration of depressive symptoms. If further supported, the finding that a dietary supplement could be good for muscles and good for the brain would provide scientific evidence of the Latin motto “mens sana in corpore sano.”

Another important aspect of the article by Burns et al. is the excellent opportunity it provides to reconsider our approach to the treatment of cancer cachexia.1 To date, we have been using the available drugs that are aimed at the syndrome rather than the patient, with conflicting results. Some patients have received clinical benefits whereas in others there was no reported decrease in muscle wasting.1 Therefore, solid conclusions could not be drawn. Recent data have shown that a patient's genetic profile is critical in determining the response to chemotherapy.5 Therefore, our interest for now should focus on better characterizing our patients by identifying those biologic markers, including genes, that may be predictive of a better response. In other and more “fashionable” words, supportive care should now move from the “prêt-a-porter” approach (i.e., the same therapeutic strategy for every cancer patient) to the “haute couture” approach (i.e., individually tailored therapeutic strategy). It is acknowledged that the costs of such comprehensive antineoplastic therapy will be higher than standard care, but it can be anticipated that cost-effectiveness will be enhanced in both the short- and long-term.

Alessandro Laviano M.D.*, Maurizio Muscaritoli M.D.*, Filippo Rossi-Fanelli M.D.*, * Department of Clinical Medicine, University La Sapienza, Rome, Italy.