PURPOSE: Ghrelin, a 28-amino acid peptide that is produced in the stomach, increases appetite, adjusts energy balance, suppresses inflammation, and enhances the release of growth hormone from the pituitary gland. The fact that the levels of ghrelin are elevated in cachectic status is known. Many clinical trials which show beneficial effects of ghrelin against loss of appetite and cachexia have been undergoing. Pathophysiological roles of ghrelin in patients who are undergoing chemotherapy and suffering a loss of appetite have yet to be known.
METHODS: We measured levels of plasma acyl and desacyl ghrelin in lung cancer patients in the first two weeks of their anticancer chemotherapies. Body weight and the amount of calorie intake were also measured. We evaluated their quality of life by using questionnaires of the European Organization Research and Treatment of Cancer, EORTC QOL-C30 and supplement lung cancer-specific module, the QOL-LC13. Adverse events (fatigue, decrease of appetite, and nausea) were accessed by using visual analog scale (VAS) during this period.
RESULTS: The plasma levels of acyl and desacyl ghrelin in lung cancer patients were gradually increased during the first two weeks of anticancer chemotherapy. Especially, the levels of ghrelin measured in the latter half of this period were significantly higher than those measured before the chemotherapy. These increases of both ghrelins were correlated with worsening of functional scales in EORTC QOL-C30. The worsening of adverse events accessed by using VAS was also correlated with the increase of plasma ghrelin levels. The counts of neutrophils were inversely correlated with the plasma levels of both ghrelins. There was no correlation between calorie intake and plasma ghrelin levels.
CONCLUSIONS: Our study suggested that ghrelin might play a compensatory role for a cachectic status induced by anticancer chemotherapy.
CLINICAL IMPLICATIONS: The produce of intrinsic ghrelin is up-regulated by the negative effects of chemotherapy. This fact suggests the possibility of ghrelin administration for cancer patients who are suffering from adverse events associated with chemotherapy.
DISCLOSURE: The following authors have nothing to disclose: Akihiro Sakamoto, Nobuhiro Matsumoto, Yasuji Arimura, Shigehisa Yanagi, Arisa Sano, Masatoshi Tokojima, Masamitsu Nakazato
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