Medikamentöse Strategien zur Gewichtszunahme bei kachektischen Patienten

 

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Zusammenfassung

Zur Behandlung des Anorexie-Kachexie-Syndroms onkologischer Patienten ist auch eine medikamentöse Therapie indiziert. Maßgebend dafür sind der klinische Zustand und die Wünsche des Patienten. Ziel der Therapie sind vorrangig eine Steigerung von Appetit und Nahrungszufuhr, eine Besserung von Wohlbefinden und Lebensqualität, dann erst von Ernährungsstatus und Überleben. Von den „empfohlenen” Medikamenten steigern Prokinetika den Appetit, verbessern Glukokortikoide und Gestagene Appetit und Wohlbefinden und beeinflussen Gestagene den Ernährungszustand positiv. Gestagene (MA) sind auch am besten untersucht. Von den „neuen” Medikamenten wirken Cannabinoide und Thalidomid auf Appetit, Wohlbefinden und Lebensqualität, Melatonin, nichtsteroidale Antiphlogistika und n-3-Fettsäuren zusätzlich auf den Ernährungszustand und das Überleben. Aufgrund fehlender Wirksamkeit und teilweise negativer Effekte nicht empfohlen wird die Anwendung von Cyproheptadin, Hydrazinsulfat und Pentoxifyllin. Anabole androgene Steroide, β₂-Adrenozeptoragonisten, Wachstumshormon und IGF-1 sollen aufgrund widersprüchlicher oder bei Tumorpatienten bisher fehlender Untersuchungen nicht außerhalb von Studien eingesetzt werden.

Abstract

Treatment of the anorexia-cachexia-syndrome of tumor patients also involves drug therapy. The clinical condition and the wishes of the patient determine, which drugs should be used. The goals of treatment are primarily to increase appetite and food consumption, to improve the general well-being and quality of life, and then to raise nutritional status and prolong survival. Of the „recommended” drugs prokinetics increase appetite, glucocorticoids and gestagenes increase appetite and well-being, and gestagenes also have a positive impact on nutritional status. Gestagenes (MA) are also the most fully tested of these drugs. Of the „new” drugs, cannabinoids and thalidomide influence appetite, general well-being, and quality of life, melatonin, non-steroidal antiphologistics and n-3-fatty acids in addition have an impact on nutritional status and survival. Not recommended, owing to ineffectiveness and even negative effects, are cyproheptadine, hydrazine sulfate and pentoxifylline. The application of anabolic androgene steroids, β₂-adrenoceptor agonists as well as growth hormone or IGF-1 is recommended only in controlled clinical trials based on inconsistent results respectively till now lacking studies with cancer patients.

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Dr. G. Zürcher

Sektion Ernährungsmedizin und Diätetik · Universitätsklinik Freiburg · Abt. 1 - Hämatologie, Onkologie

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