Library Subscription: Guest
Critical Reviews™ in Oncogenesis

Published 4 issues per year

ISSN Print: 0893-9675

ISSN Online: 2162-6448

SJR: 0.395 SNIP: 0.322 CiteScore™:: 2.5 H-Index: 54

Indexed in

Cytokine Involvement in Cancer Anorexia/ Cachexia: Role of Megestrol Acetate and Medroxyprogesterone Acetate on Cytokine Downregulation and Improvement of Clinical Symptoms

Volume 9, Issue 2, 1998, pp. 99-106
DOI: 10.1615/CritRevOncog.v9.i2.10
Get accessGet access

ABSTRACT

The characteristic clinical picture of anorexia, tissue wasting, loss of body weight accompanied by a decrease in muscle mass and adipose tissue, and poor performance status that often precedes death has been named the cancer-related anorexia/cachexia syndrome (CACS). Chronic administration of pro-inflammatory cytokines, including interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor (TNF) either alone or in combination, is capable of reproducing the diferent features of CACS. High serum levels of these cytokines have been found in cancer patients, which seem to correlate with progression of the tumor. This paper describes a series of experimental and clinical studies demonstrating that: (1) high serum levels of some cytokines, including IL-1, IL-6, and TNF, are present in advanced-stage cancer patients, particularly those with CACS; (2) megestrol acetate (MA) has a beneficial therapeutic effect on CACS symptoms, such as appetite, body weight, and quality-of-life; (3) MA downregulates the synthesis and release of cytokines and relieves the symptoms of CACS; (4) cytokines play a key role in the onset of CACS; (5) medroxyprogesterone acetate (MPA) reduces the in vitro production of cytokines and serotonin (5-hydroxytryptamine, 5-HT) by peripheral blood mononuclear cells (PBMC) of cancer patients; and (6) MA and MPA reduce the cisplatin-induced 5-HT release in vitro from PBMC of cancer patients. Based on these results, a clinical study incorporating MA/MPA in combination with chemotherapy or chemo-immunotherapy may be warranted.

CITED BY
  1. Kovesdy Csaba P., Kalantar-Zadeh Kamyar, Inflammation in Chronic Kidney Disease, in Chronic Kidney Disease, Dialysis, and Transplantation, 2010. Crossref

  2. Waterston A. M., Gumbrell L., Bratt T., Waller S., Gustav-Aspland J., L‘Hermenier C, Bellenger K, Campbell M, Powles T, Highley M, Bower M, Mouritsen S., Feldmann M., Coombes R. C., Phase I study of TNFα AutoVaccIne in Patients with metastatic cancer, Cancer Immunology, Immunotherapy, 54, 9, 2005. Crossref

  3. Gołębiewska Justyna E., Lichodziejewska-Niemierko Monika, Aleksandrowicz-Wrona Ewa, Majkowicz Mikołaj, Łysiak-Szydłowska Wiesława, Rutkowski Bolesław, Influence of megestrol acetate on nutrition, inflammation and quality of life in dialysis patients, International Urology and Nephrology, 44, 4, 2012. Crossref

  4. Laviano Alessandro, Meguid Michael, Rossi-Fanelli Filippo, , Current Opinion in Clinical Nutrition & Metabolic Care, 6, 4, 2003. Crossref

  5. Reyes-Gibby Cielito C., Wang Jian, Spitz Margaret, Wu Xifeng, Yennurajalingam Sriram, Shete Sanjay, Genetic Variations in Interleukin-8 and Interleukin-10 Are Associated With Pain, Depressed Mood, and Fatigue in Lung Cancer Patients, Journal of Pain and Symptom Management, 46, 2, 2013. Crossref

  6. Mantovani Giovanni, Madeddu Clelia, Gramignano Giulia, Rita Lusso Maria, Mocci Miria, Massa Elena, Ferreli Luca, Astara Giorgio, Macciò Antonio, Serpe Roberto, Subcutaneous interleukin-2 in combination with medroxyprogesterone acetate and antioxidants in advanced cancer responders to previous chemotherapy: phase II study evaluating clinical, quality of life, and laboratory parameters, Journal of Experimental Therapeutics and Oncology, 3, 4, 2003. Crossref

  7. Macciò Antonio, Madeddu Clelia, Mantovani Giovanni, Current pharmacotherapy options for cancer anorexia and cachexia, Expert Opinion on Pharmacotherapy, 13, 17, 2012. Crossref

  8. Eubanks Valerie, Koppersmith Nicki, Wooldridge Nancy, Clancy J.P., Lyrene Raymond, Arani Ramin B., Lee Jeanette, Moldawer Lyle, Atchison Joy, Sorscher Eric J., Makris Christopher M., Effects of megestrol acetate on weight gain, body composition, and pulmonary function in patients with cystic fibrosis, The Journal of Pediatrics, 140, 4, 2002. Crossref

  9. Yeh Shing-shing, Schuster Michael W, Megestrol acetate in cachexia and anorexia, International Journal of Nanomedicine, 1, 4, 2006. Crossref

  10. Ruiz-García Vicente, Juan Óscar, Pérez Hoyos Santiago, Peiró Rosana, Ramón Nieves, Ángeles Rosero M., Ángel García Miguel, Acetato de megestrol: una revisión sistemática de su utilidad clínica para la ganancia de peso en los enfermos con neoplasia y caquexia, Medicina Clínica, 119, 5, 2002. Crossref

  11. Argilés Josep M., Anguera Anna, Stemmler Britta, A new look at an old drug for the treatment of cancer cachexia: Megestrol acetate, Clinical Nutrition, 32, 3, 2013. Crossref

  12. Ruiz Garcia Vicente, López-Briz Eduardo, Carbonell Sanchis Rafael, Gonzalvez Perales Jose Luis, Bort-Martí Sylvia, Megestrol acetate for treatment of anorexia-cachexia syndrome, Cochrane Database of Systematic Reviews, 2013. Crossref

  13. Laviano Alessandro, Inui Akio, Meguid Michael M., Molfino Alessio, Conte Caterina, Rossi Fanelli Filippo, NPY and brain monoamines in the pathogenesis of cancer anorexia, Nutrition, 24, 9, 2008. Crossref

  14. Khalil Alizan A., Hall John C., Aziz Farah A., Price Patricia, TUMOUR NECROSIS FACTOR: IMPLICATIONS FOR SURGICAL PATIENTS, ANZ Journal of Surgery, 76, 11, 2006. Crossref

  15. Kayacan Oya, Karnak Demet, Beder Sumru, Güllü Emine, Tutkak Hüseyin, Şenler Filiz Çay, Köksal Deniz, Impact of TNF-α and IL-6 Levels on Development of Cachexia in Newly Diagnosed NSCLC Patients, American Journal of Clinical Oncology, 29, 4, 2006. Crossref

  16. Mantovani Giovanni, Cachexia and anorexia, Supportive Care in Cancer, 8, 6, 2000. Crossref

  17. Laviano Alessandro, Meguid Michael M, Rossi-Fanelli Filippo, Cancer anorexia: clinical implications, pathogenesis, and therapeutic strategies, The Lancet Oncology, 4, 11, 2003. Crossref

  18. Kalantar-Zadeh Kamyar, Stenvinkel Peter, Bross Rachelle, Khawar Osman S, Rammohan Meenakshi, Colman Sara, Benner Debbie, Kidney insufficiency and nutrient-based modulation of inflammation, Current Opinion in Clinical Nutrition and Metabolic Care, 8, 4, 2005. Crossref

  19. Kovesdy Csaba P, Kalantar-Zadeh Kamyar, Novel targets and new potential: developments in the treatment of inflammation in chronic kidney disease, Expert Opinion on Investigational Drugs, 17, 4, 2008. Crossref

  20. Tassinari Davide, Fochessati Francesca, Panzini Ilaria, Poggi Barbara, Sartori Sergio, Ravaioli Alberto, Rapid Progression of Advanced “Hormone-Resistant” Prostate Cancer During Palliative Treatment with Progestins for Cancer Cachexia, Journal of Pain and Symptom Management, 25, 5, 2003. Crossref

  21. Macciò Antonio, Madeddu Clelia, Gramignano Giulia, Mulas Carlo, Floris Carlo, Sanna Eleonora, Cau Maria Chiara, Panzone Filomena, Mantovani Giovanni, A randomized phase III clinical trial of a combined treatment for cachexia in patients with gynecological cancers: Evaluating the impact on metabolic and inflammatory profiles and quality of life, Gynecologic Oncology, 124, 3, 2012. Crossref

  22. Langer Corey J., Hoffman John P., Ottery Faith D., Clinical Significance of weight loss in cancer patients: Rationale for the use of anabolic agents in the treatment of cancer-related cachexia, Nutrition, 17, 1, 2001. Crossref

  23. Bodenner Donald, Spencer Trey, Riggs Ann T., Redman Carolyn, Strunk Billy, Hughes Tony, A retrospective study of the association between megestrol acetate administration and mortality among nursing home residents with clinically significant weight loss, The American Journal of Geriatric Pharmacotherapy, 5, 2, 2007. Crossref

  24. Laviano Alessandro, Meguid Michael M., Rossi-Fanelli Filippo, Improving food intake in anorectic cancer patients, Current Opinion in Clinical Nutrition & Metabolic Care, 6, 4, 2003. Crossref

  25. Busquets Sílvia, Serpe Roberto, Sirisi Sónia, Toledo Míriam, Coutinho Joana, Martínez Raquel, Orpí Marcel, López-Soriano Francisco J., Argilés Josep M., Megestrol acetate: Its impact on muscle protein metabolism supports its use in cancer cachexia, Clinical Nutrition, 29, 6, 2010. Crossref

  26. Wickremesekera J.Kesara, Chen Wangxue, Cannan Rebecca J, Stubbs Richard S, Serum proinflammatory cytokine response in patients with advanced liver tumors following selective internal radiation therapy (SIRT) with 90Yttrium microspheres, International Journal of Radiation Oncology*Biology*Physics, 49, 4, 2001. Crossref

  27. Toledo Míriam, Penna Fabio, Oliva Francesc, Luque Melania, Betancourt Angelica, Marmonti Enrica, López-Soriano Francisco J., Argilés Josep M., Busquets Sílvia, A multifactorial anti-cachectic approach for cancer cachexia in a rat model undergoing chemotherapy, Journal of Cachexia, Sarcopenia and Muscle, 7, 1, 2016. Crossref

  28. Chambers Kathleen C., Conditioned Taste Aversions, in Handbook of Olfaction and Gustation, 2015. Crossref

  29. Geary Nori, Sex differences in disease anorexia, Nutrition, 17, 6, 2001. Crossref

  30. Molfino Alessio, Gioia Gianfranco, Fanelli Filippo Rossi, Laviano Alessandro, Contribution of Neuroinflammation to the Pathogenesis of Cancer Cachexia, Mediators of Inflammation, 2015, 2015. Crossref

  31. Wang Wenhua, Danielsson Anna, Svanberg Elisabeth, Lundholm Kent, Lack of effects by tricyclic antidepressant and serotonin inhibitors on anorexia in MCG 101 tumor-bearing mice with eicosanoid-related cachexia, Nutrition, 19, 1, 2003. Crossref

  32. Ezeoke Chukwuemeka Charles, Morley John E., Pathophysiology of anorexia in the cancer cachexia syndrome, Journal of Cachexia, Sarcopenia and Muscle, 6, 4, 2015. Crossref

  33. Marsden Donald E., Lickiss J.Norelle, Hacker Neville F., Gastrointestinal problems in patients with advanced gynaecological malignancy, Best Practice & Research Clinical Obstetrics & Gynaecology, 15, 2, 2001. Crossref

  34. Endokrines System und Immunmodulation, in Arzneimitteltherapie in der Palliativmedizin, 2015. Crossref

  35. Rammohan Meenakshi, Kalantar-Zadeh Kamyar, Liang Alexander, Ghossein Cybele, Megestrol Acetate in a Moderate Dose for the Treatment of Malnutrition-Inflammation Complex in Maintenance Dialysis Patients, Journal of Renal Nutrition, 15, 3, 2005. Crossref

  36. Piccolomini Francesco, LouWratten Mary, Sereni Luisa, Balestreri Ettore, Donadio Elena, Felicioli Antonio, Felicioli Roman, Donadio Carlo, Effects of the incubation in vitro with sorbents on serum proteomic pattern and cytokine concentration in cancer patients during chemotherapy—preliminary results, Biomedicine & Pharmacotherapy, 60, 8, 2006. Crossref

  37. Zhang Dianliang, Zheng Hongmei, Zhou Yanbing, Tang Xingming, Yu Baojun, Li Jieshou, Association of IL-1beta gene polymorphism with cachexia from locally advanced gastric cancer, BMC Cancer, 7, 1, 2007. Crossref

  38. Chen Jane Q., Mori Hidetoshi, Cardiff Robert D., Trott Josephine F., Hovey Russell C., Hubbard Neil E., Engelberg Jesse A., Tepper Clifford G., Willis Brandon J., Khan Imran H., Ravindran Resmi K., Chan Szeman R., Schreiber Robert D., Borowsky Alexander D., Seagroves Tiffany, Abnormal Mammary Development in 129:STAT1-Null Mice is Stroma-Dependent, PLOS ONE, 10, 6, 2015. Crossref

  39. Molfino Alessio, Iannace Alessandro, Colaiacomo Maria Chiara, Farcomeni Alessio, Emiliani Alessandra, Gualdi Gianfranco, Laviano Alessandro, Rossi Fanelli Filippo, Cancer anorexia: hypothalamic activity and its association with inflammation and appetite-regulating peptides in lung cancer, Journal of Cachexia, Sarcopenia and Muscle, 8, 1, 2017. Crossref

  40. Madeddu Clelia, Macciò Antonio, Panzone Filomena, Tanca Francesca Maria, Mantovani Giovanni, Medroxyprogesterone acetate in the management of cancer cachexia, Expert Opinion on Pharmacotherapy, 10, 8, 2009. Crossref

  41. Musolino Vincenzo, Palus Sandra, Tschirner Anika, Drescher Cathleen, Gliozzi Micaela, Carresi Cristina, Vitale Cristiana, Muscoli Carolina, Doehner Wolfram, von Haehling Stephan, Anker Stefan D., Mollace Vincenzo, Springer Jochen, Megestrol acetate improves cardiac function in a model of cancer cachexia-induced cardiomyopathy by autophagic modulation, Journal of Cachexia, Sarcopenia and Muscle, 7, 5, 2016. Crossref

  42. Laviano Alessandro, Inui Akio, Marks Daniel L., Meguid Michael M., Pichard Claude, Rossi Fanelli Filippo, Seelaender Marilia, Neural control of the anorexia-cachexia syndrome, American Journal of Physiology-Endocrinology and Metabolism, 295, 5, 2008. Crossref

  43. Guan Michelle, Shinde Arvind M., Hendifar Andrew E., Pancreatic Cancer Cachexia: Current Concepts and Clinical Management, in Frailty and Sarcopenia - Onset, Development and Clinical Challenges, 2017. Crossref

  44. House Larry, Seminerio Michael J., Mirkov Snezana, Ramirez Jacqueline, Skor Maxwell, Sachleben Joseph R., Isikbay Masis, Singhal Hari, Greene Geoffrey L., Vander Griend Donald, Conzen Suzanne D., Ratain Mark J., Metabolism of megestrol acetate in vitro and the role of oxidative metabolites, Xenobiotica, 48, 10, 2018. Crossref

  45. Le Thuc Ophélia, Rovère Carole, Inflammation hypothalamique et dérégulations de la balance énergétique : focus sur les chimiokines, Biologie Aujourd'hui, 210, 4, 2016. Crossref

  46. KIM AEYUNG, IM MINJU, MA JIN YEUL, Sosiho-tang ameliorates cachexia-related symptoms in mice bearing colon 26 adenocarcinoma by reducing systemic inflammation and muscle loss, Oncology Reports, 35, 3, 2016. Crossref

  47. Le Thuc Ophélia, Stobbe Katharina, Cansell Céline, Nahon Jean-Louis, Blondeau Nicolas, Rovère Carole, Hypothalamic Inflammation and Energy Balance Disruptions: Spotlight on Chemokines, Frontiers in Endocrinology, 8, 2017. Crossref

  48. Hung Chia-Yen, Lin Tung-Liang, Kuo Yung-Chia, Hsieh Chia-Hsun, Wang Hung-Ming, Hsu Cheng-Lung, Progesterone analogues reduce plasma Epstein–Barr virus DNA load and improve pain control in recurrent/metastatic nasopharyngeal carcinoma patients under supportive care, Biomedical Journal, 40, 4, 2017. Crossref

  49. Endokrines System und Immunmodulation, in Arzneimitteltherapie in der Palliativmedizin, 2018. Crossref

  50. Kim Yeol, Symptom Management for Cancer Patients, The Korean Journal of Hospice and Palliative Care, 15, 2, 2012. Crossref

  51. Wang Zhuangzhi, Zhao Chunfang, Moya Rosa, Davies Joanna D., A Novel Role for CD4+T Cells in the Control of Cachexia, The Journal of Immunology, 181, 7, 2008. Crossref

  52. Narsale Aditi, Moya Rosa, Ma Jasmin, Anderson Lindsey J., Wu Daniel, Garcia Jose M., Davies Joanna D., Cancer‐driven changes link T cell frequency to muscle strength in people with cancer: a pilot study, Journal of Cachexia, Sarcopenia and Muscle, 10, 4, 2019. Crossref

  53. Yoon Saunjoo L, Grundmann Oliver, Williams Joseph J, Wu Samuel S, Leeuwenburgh Christiaan, Huo Zhiguang, George Thomas J, Differential response to targeted acupuncture by gender in patients with gastrointestinal cancer cachexia: secondary analysis of a randomized controlled trial, Acupuncture in Medicine, 38, 1, 2020. Crossref

  54. Desai Jayesh, Gold Michelle, Fullerton Sonia, Cebon Jonathan, Systemic Manifestations of Cancer and Paraneoplastic Syndromes, in Current Cancer Therapeutics, 2001. Crossref

  55. Liu Yi, Jia Zhongwu, Dong Lei, Wang Rui, Qiu Genquan, A Randomized Pilot Study of Atractylenolide I on Gastric Cancer Cachexia Patients, Evidence-Based Complementary and Alternative Medicine, 5, 3, 2008. Crossref

  56. Dahele Max, Fearon Kenneth C. H., Pharmaco-Nutritional Supports for the Treatment of Cancer Cachexia, in Cachexia and Wasting: A Modern Approach, 2006. Crossref

  57. Tassinari Davide, Maltoni Marco, Progestagens and Corticosteroids in the Management Cancer Cachexia, in Cachexia and Wasting: A Modern Approach, 2006. Crossref

  58. Amagai Teruyoshi, Kaneko Michio, Hori Tetsuo, Kirii Kyoko, Hypoleptinemia Associated with Hypermetabolism, Low Adiposity Body Composition and Overeating Behavior in Children with Jaundiced Biliary Atresia, Journal of the Human-Environment System, 5, 1, 2001. Crossref

  59. Thomas David R., Cytokines and Disability in Older Adults, in Cachexia and Wasting: A Modern Approach, 2006. Crossref

  60. Yeh Shing-Shing, Schuster Michael W., Treatment of Cachexia in the Elderly, in Cachexia and Wasting: A Modern Approach, 2006. Crossref

  61. Marceca Gioacchino P., Londhe Priya, Calore Federica, Management of Cancer Cachexia: Attempting to Develop New Pharmacological Agents for New Effective Therapeutic Options, Frontiers in Oncology, 10, 2020. Crossref

  62. Suzuki Tsuyoshi, Ebner Nicole, Palus Sandra, Haehling Stephan, Springer Jochen, Progesterone improves survival in hepatoma cachexia rat model, JCSM Rapid Communications, 3, 1, 2020. Crossref

  63. Zhou Da, Zhang Ying, Gao Xuejin, Yang Jianbo, Li Guoli, Wang Xinying, Long-Term Outcome in Gastric Cancer Patients with Different Body Composition Score Assessed via Computed Tomography, Journal of Investigative Surgery, 34, 8, 2021. Crossref

  64. Maltoni M., Nanni O., Scarpi E., Rossi D., Serra P., Amadori D., High-dose progestins for the treatment of cancer anorexia–cachexia syndrome: A systematic review of randomised clinical trials, Annals of Oncology, 12, 3, 2001. Crossref

  65. Fatima Kaneez, Andleeb Asifa, Hussain Imtiyaz, Sofi MushtaqAhmed, Fir Afroz, Qadri SumyraKhurshid, Megestrol acetate in cancer cachexia and anorexia: Tertiary care experience, Journal of Radiation and Cancer Research, 12, 4, 2021. Crossref

  66. Madeddu Clelia, Macciò Antonio, Cau Maria Chiara, Serpe Roberto, Mantovani Giovanni, Current medications for cancer cachexia, in Cancer Cachexia, 2013. Crossref

  67. Frisoli Jr Alberto, Paes Angela Tavares, Borges Jairo, Ingham Sheila McNeill, Cartocci Monica Maria, Lima Eliene, de Camargo Carvalho Antonio Carlos, The association between low lean mass and osteoporosis increases the risk of weakness, poor physical performance and frailty in Brazilian older adults: data from SARCOS study, European Journal of Clinical Nutrition, 75, 3, 2021. Crossref

  68. Goldman Ann, Hewitt Martin, Collins Gary S., Childs Margaret, Hain Richard, Symptoms in Children/Young People With Progressive Malignant Disease: United Kingdom Children's Cancer Study Group/Paediatric Oncology Nurses Forum Survey, Pediatrics, 117, 6, 2006. Crossref

  69. Li Yongxiang, Jiang Qingyan, Wang Lina, Appetite Regulation of TLR4-Induced Inflammatory Signaling, Frontiers in Endocrinology, 12, 2021. Crossref

  70. Endokrines System und Immunmodulation, in Arzneimitteltherapie in der Palliativmedizin, 2022. Crossref

  71. Davis Mellar P., Dreicer Robert, Walsh Declan, Lagman Ruth, LeGrand Susan B., Appetite and Cancer-Associated Anorexia: A Review, Journal of Clinical Oncology, 22, 8, 2004. Crossref

  72. Lee Bang-Ning, Reuben James M., Proteins and symptoms, in Cancer Symptom Science, 2010. Crossref

  73. Kalantar-Zadeh Kamyar, Anker Stefan D., Horwich Tamara B., Fonarow Gregg C., Nutritional and Anti-Inflammatory Interventions in Chronic Heart Failure, The American Journal of Cardiology, 101, 11, 2008. Crossref

  74. Hegde Mangala, Daimary Uzini Devi, Girisa Sosmitha, Kumar Aviral, Kunnumakkara Ajaikumar B, Tumor cell anabolism and host tissue catabolism-energetic inefficiency during cancer cachexia, Experimental Biology and Medicine, 247, 9, 2022. Crossref

  75. Wen Hong-Sheng, Li Xu, Cao Yu-Zhu, Zhang Cui-Cui, Yang Fang, Shi Yu-Ming, Peng Li-Ming, Clinical Studies on the Treatment of Cancer Cachexia with Megestrol Acetate plus Thalidomide, Chemotherapy, 58, 6, 2012. Crossref

  76. Kovesdy Csaba, Kalantar-Zadeh Kamyar, Protein-Energy Wasting as a Risk Factor of Morbidity and Mortality in Chronic Kidney Disease, in Nutritional Management of Renal Disease, 2013. Crossref

  77. Baba Mudasir R, Buch Sajad A, Revisiting Cancer Cachexia: Pathogenesis, Diagnosis, and Current Treatment Approaches, Asia-Pacific Journal of Oncology Nursing, 8, 5, 2021. Crossref

  78. Chambers Kathleen C., Conditioned taste aversions, World Journal of Otorhinolaryngology - Head and Neck Surgery, 4, 1, 2018. Crossref

  79. Maltais François, Decramer Marc, Casaburi Richard, Barreiro Esther, Burelle Yan, Debigaré Richard, Dekhuijzen P. N. Richard, Franssen Frits, Gayan-Ramirez Ghislaine, Gea Joaquim, Gosker Harry R., Gosselink Rik, Hayot Maurice, Hussain Sabah N. A., Janssens Wim, Polkey Micheal I., Roca Josep, Saey Didier, Schols Annemie M. W. J., Spruit Martijn A., Steiner Michael, Taivassalo Tanja, Troosters Thierry, Vogiatzis Ioannis, Wagner Peter D., An Official American Thoracic Society/European Respiratory Society Statement: Update on Limb Muscle Dysfunction in Chronic Obstructive Pulmonary Disease, American Journal of Respiratory and Critical Care Medicine, 189, 9, 2014. Crossref

  80. De Brandt Jana, Beijers Rosanne JHCG, Chiles Joe, Maddocks Matthew, McDonald Merry-Lynn N, Schols Annemie MWJ, Nyberg André, Update on the Etiology, Assessment, and Management of COPD Cachexia: Considerations for the Clinician, International Journal of Chronic Obstructive Pulmonary Disease, Volume 17, 2022. Crossref

Begell Digital Portal Begell Digital Library eBooks Journals References & Proceedings Research Collections Prices and Subscription Policies Begell House Contact Us Language English 中文 Русский Português German French Spain