Cancer cachexia is sometimes referred to as the "last disease" because it often becomes apparent in the later stages of cancer. However, a new picture is emerging whereby many patients are already affected by cachexia when they first appear in the clinic. This has major implications for treatment..

Cancer cachexia is a severe and often overlooked condition that affects up to 80% of cancer patients. It is characterized by the unintended loss of body weight and muscle mass, often accompanied by fat loss, decreased appetite, and extreme fatigue. It has been referred to as a wasting disorder and involves complex metabolic and inflammatory changes in the body. This syndrome significantly reduces a patient's quality of life, tolerance to treatment, and overall survival. Cachexia is a critical factor in the decline of patients with advanced cancer, contributing significantly to mortality and often marking a stage where the focus shifts to palliative care rather than curative treatment.

Historically, oncologists often ignored cachexia and focused on treating the cancer. The idea being that the cancer is causing the cachexia, so if we get the cancer controlled, the cachexia will follow. New information suggests that we need to flip our thinking.

The presence of cachexia influences the efficacy of the cancer treatments. Immunotherapies, chemotherapies and targeted therapies are less effective in patients showing cancer cachexia symptoms. Additionally, the toxicity effects of some treatments can be especially damaging in patients who are already suffering from cachexia.

So, we have a new picture in which we need to address cachexia as a first priority to give each patient the best chance at a good treatment outcome. But there are challenges.

1. Lack of Effective Therapies: Currently, there are no FDA-approved medications or treatments specifically for cancer cachexia. We lack a full mechanistic understanding of the disorder to develop treatments. Research is essential to develop effective treatments that can help manage or reverse this condition, thereby improving the lives of many cancer patients.

2. Early Detection and Intervention: We lack effective approaches to diagnose cachexia risks early when interventions are most effective. We need reliable biomarkers and screening tools to detect cachexia at its onset and delieneate important subtypes. Early intervention can prevent severe weight loss and muscle wasting, improving patients' overall health and treatment response.

To build a roadmap for cancer cachexia solutions, I was honored to be part of a working group atthe Moffitt Cancer Center that focused on identifying the core challenges and pointing to solutions. With Storyline Health AI technologies, we propose building scalable behavioral AI biomarkers of cachexia symptoms and risk. These will help detect cachexia symptoms early, precisely, objectively, and quantitatively.

This work is urgent. Believe it or not, weight loss and cachexia symptoms are frequently the first things patients notice. These symptoms drive them to come into the clinic where they ultimately receive a cancer diagnosis. The earlier we detect cancer cachexia, the earlier we can help people.

A massively scalable solution is urgently needed. We are working on it. Storyline is a smartphone-based platform for behavioral AI. It captures tens of thousands of measures of appearance, behavior, speech, and vocal patterns to build robust biomarkers and predictive models. By creating a cachexia risk biomarker using Storyline deep phenotyping technology, we expect to be able to help detect cancer cachexia symptoms remotely in patients and steer them to get care sooner. We will also be able to monitor patients and subtype them, to guide care.

There is so much good to be done and opportunities to help. Don’t overlook cachexia. It is a big factor that must not be ignored.

To read the Cachexia Working Groups recommendations, please see this new publication in the peer reviewed journal, Cancers -

Park and Whelan et al. Defining and Addressing Research Priorities in Cancer Cachexia through Transdisciplinary Collaboration Cancers 2024, 16(13), 2364; https://doi.org/10.3390/cancers16132364

Link: https://www.mdpi.com/2072-6694/16/13/2364

Big thanks to Margaret Park, Christopher Whelan, Patricia McDonald and Jennifer Permuth for leading this charge!!!!