By Dr. Sai Vivek V
NEW DELHI (India CSR): Until recently, the root cause of cachexia was identified as the inflammatory mediators produced either by the tumour itself or the body. However, a new stream of research is about to upend this conventional wisdom, with findings indicating that cachexia could actually be a neuro-metabolic problem.
For many families, the most shocking part of a cancer journey is not the tumour itself, but the steady wasting that follows — loss of appetite, falling weight, thinning muscles, and the feeling that treatment is failing even when scans show the tumour is controlled. This condition, known as cachexia, associated with cancer, is more than merely feeling weak or having weight loss due to poor dietary habits: cachexia is a complex and serious chronic metabolic disorder that reduces survival and limits the effectiveness of chemotherapy and radiation therapy.
Until recently, the root cause of cachexia was identified as the inflammatory mediators produced either by the tumour itself or the body. However, a new stream of research is about to upend this conventional wisdom, with findings indicating that cachexia could actually be a neuro-metabolic problem. It is believed that inflammatory process might interfere with the nerve impulses between the brain and the liver, thereby reprogramming the body’s metabolic functions due to inappropriate nerve impulses, leading to severe wasting of the body. This latest discovery holds out new avenues for treatment, but also warns us that the complexity of the mechanism lying behind wasting is very subtle.
What is cachexia?
Cachexia is a syndrome marked by involuntary loss of body weight and muscle despite nutritional intake. It affects up to 80% patients with advanced cancers and accounts for a sizeable fraction of cancer deaths. Unlike starvation, cachexia involves increased energy expenditure and metabolic breakdown of muscle and fat driven by tumour–host biology. That is why simply “feeding” patients does not reliably reverse it.
What research shows
The new wave of studies has turned attention to the vagus nerve — the major highway of parasympathetic signals that carries information between the gut, liver and the brain. In experimental cancer models, persistent tumour-related inflammation appears to alter vagal signalling. That, in turn, leads to changes in the liver’s gene programmes, notably suppression of HNF4α, a master regulator of hepatic metabolism. When the liver’s metabolic balance tips, it releases factors and metabolic products that promote anorexia (loss of appetite), systemic inflammation, and muscle wasting — the hallmarks of cachexia.
Put simply: tumour → inflammation → vagal dysregulation → liver reprogramming → whole-body wasting. This reframes cachexia as more than peripheral inflammation; it is organ crosstalk gone awry.
Why the liver matters
The liver is the metabolic powerhouse of the human body. Apart from digesting nutrients, it synthesises proteins, controls energy reserves, and also participates in the regulation of immune signals.
Recently, metabolomic analyses of animal models and human samples have revealed a number of characteristic alterations in liver biochemistry under cachexia, diminished vitamin B-dependent enzymes, changed amino acid metabolism, and deranged lipid metabolism. These liver changes are not solitary events; they alter the composition of the blood and send signals to the muscle and brain, thus upregulating the catabolic process.
Reversing cachexia
The most striking part of the recent work is how reversible some of these pathways appear in the lab. In mice, interrupting the maladaptive vagal signal or preventing HNF4α loss in the liver blunted weight loss and muscle wasting. Researchers are starting to look into the possibility that electrical stimulation of the vagus nerve, with the help of wearable or implantable devices, might be able to fight cancer-related cachexia.
The focus can also now be moved from individual cytokines to the neuro-metabolic circuit. That change in perspective is a good explanation as to why anti-cytokine drugs, just by themselves, have generally been unsuccessful, and it also brings up several potential new interventions, neuromodulation, liver-directed metabolic support, or drugs that restore hepatic transcriptional programmes.
The initial results are encouraging but the majority of the evidence has been obtained from preclinical studies only. Human biology is enormously complicated and, to establish the safety and effectiveness of such therapy, to check that it would not adversely affect anti-cancer immunity or ongoing treatments, well-designed clinical trials are absolutely necessary.
What this means
For clinicians, the updated framework supports some practical points that have already been surfacing from cachexia research:
One should never delay in recognising the disease. It is easier to slow down cachexia at an early stage than to reverse it at a late stage. The patient’s weight, muscle strength, and appetite should be checked regularly. Treat the whole patient, not just the cancer. The best way to preserve a patient’s function is to combine anti-inflammatory strategies, targeted nutritional support, exercise if possible, and symptom control for nausea or pain.
Research trials are important. Do not hesitate to tell patients who are eligible that they should take part in clinical trials of cachexia therapies so that we will know what really works in humans, not just in animals, in the future.
Cachexia remains neglected, but these emerging brain–liver insights offer hope; early detection, combined care, and clinical research remain key today.
About the Author
Dr. Sai Vivek V, Consultant – Medical Oncology and Haemato – Oncology.
(India CSR)
