Cardiac cachexia: the mandate to increase clinician awareness Purpose of review Heart failure is a frequent problem in an ageing population, associated with high rates of morbidity and mortality. Today, it is important to not only treat heart failure itself but also the related comorbidities. Among them, cardiac cachexia is one of the major challenges. It is a complex multifactorial disease with a negative impact on quality of life and prognosis. Therefore, prevention, early recognition and treatment of cardiac cachexia is essential. Recent findings Cardiac cachexia frequently presents with skeletal as well as heart muscle depletion. Imaging-based diagnostic techniques can help to identify patients with cardiac cachexia and muscle wasting. Several blood biomarkers are available to detect metabolic changes in cardiac cachexia. Summary Several studies are currently ongoing to better comprehend the underlying pathophysiological mechanisms of cardiac cachexia and to find new treatments. It is essential to diagnose it as early as possible to initiate therapy. Correspondence to Markus S. Anker, MD, Department of Cardiology, Campus Benjamin Franklin (CBF), Charité University Medicine, Berlin, Germany. E-mail: markus.anker@charite.de Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

From cachexia to obesity: the role of host metabolism in cancer immunotherapy Purpose of review Currently, several clinical trials in cancer therapy have demonstrated the success of immunomodulatory therapies. However, only a variable fraction of patients actually benefit from these treatments. The understanding of key mechanisms behind this response heterogeneity is one of the major unmet need and intense research field in immuno-oncology. This review will discuss the host metabolic dysfunctions derived from cachexia or obesity that can affect the response to cancer immunotherapy. Recent findings Preclinical studies demonstrated that chronic inflammation, nutritional intake impairment and endocrine dysfunction may affect anticancer innate and adaptive immunity, both in cachexia and obesity. New emerging clinical findings have highlighted the impact of metabolic biomarkers in predicting response to immune checkpoint inhibitors in cancer patients. Summary Patient's weight and inflammatory status could be relevant in the clinical decision-making process before starting cancer immunotherapy and for an effective patient selection and stratification in future clinical trials employing this class of anticancer agents. Correspondence to Davide Brocco, Medical Oncology Unit, SS Annunziata Hospital, Chieti, Italy. Tel: +39 3291967107; e-mail: davide.brocco1@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Cancer cachexia and treatment toxicity Purpose of review Cancer cachexia is a metabolic disturbance resulting in a loss of skeletal muscle mass that is generally not reversed through traditional nutritional interventions. We review on both the impact of nutritional status on cancer treatment side effects, as well as cancer- specific outcomes. Recent findings Cancer-specific cachexia and sarcopenia are associated with increased treatment-associated toxicity, and overall worse cancer-specific outcomes across all cancer types in surgical, chemotherapeutic, and radiotherapeutic populations. Despite the fact that cancer cachexia is generally thought to be irreversible, there is some evidence that nutritional intervention can be helpful. Summary Nutritional status is an important factor to consider in determining cancer therapy. Patients with poor nutritional status should be identified prior to the initiation of therapy and be monitored judiciously. Correspondence to Varun Kumar Chowdhry, MD, Assistant Professor of Oncology, Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA. Tel: +1 716 845 3173; fax: +1 716 845 3549; e-mail: Varun.Chowdhry@RoswellPark.org Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Sarcopenia: looking to muscle mass to better manage pancreatic cancer patients Purpose of review Overall survival of patients with pancreatic cancer is strongly conditioned by tumor biology and the incidence of malnutrition and metabolic disorders. In this landscape, the assessment of body composition is crucial to properly manage the clinical implications of muscle wasting. The pathogenesis of this condition is the result of a complex interplay between cancer and the host. In particular, sarcopenia is induced by an inadequate nutritional intake, hormonal abnormalities, inflammation and imbalance between anabolic and catabolic pathways. Recent findings Recent evidences have highlighted the role of sarcopenia in cancer patients, revealing a prognostic impact on morbidity, mortality and survival. Summary The occurrence of sarcopenia could amplify chemotherapy-induced toxicities, prolong hospitalizations and reduce adherence to anticancer treatment, worsening quality of life and survival. Although considerable efforts have been made to develop treatment strategies, no effective interventions have been identified so far. Nevertheless, if promptly and adequately supported, pancreatic cancer might benefit from adopted dietary intervention to avoid further loss of lean mass. Correspondence to Giuseppe Aprile, MD, Department of Oncology, San Bortolo General Hospital, ULSS8 Berica, East District, Vicenza, Italy. Tel: +39 0444 753259; fax: +39 0444 757341; e-mail: giuseppe.aprile@aulss8.veneto.it Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Dietetic assessment and intervention in lung cancer Purpose of review Systemic therapy for lung cancer is increasing in intensity and duration. European nutrition guidelines suggest screening for weight loss and malnutrition, however acknowledges there is a lack of evidence. We discuss current data round this issue and identify opportunities for further research. Recent findings International guidelines now exist to aid the definition of weight loss in cancer, including cachexia, sarcopenia and malnutrition. These allow consistent definition of overlapping, but distinct clinical syndromes. Nutritional status can be assessed in a range of ways including questionnaires, functional assessments, blood markers, physical activity, weight and BMI. Weight loss is commonly associated with a proinflammatory state. Future treatment is likely to be a combination of dietetic support and pharmacological treatment of cachexia. Summary There is a paucity of data on dietetic intervention. It is potentially quick, inexpensive and patient specific, using a holistic approach to aid patients who are malnourished or at risk of malnutrition. Lung cancer-related weight loss is common, further strategies are needed to effectively assess and intervene. Dietetic intervention has the potential to improve patients’ quality of life and outcomes. Correspondence to Dr Iain Phillips, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK. Tel: +0131 537 1000; e-mail: iain.phillips1@nhs.net Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Ketamine and lidocaine infusions decrease opioid consumption during vaso-occlusive crisis in adolescents with sickle cell disease Purpose of review Recurrent exposure to opioids can lead to development of opioid tolerance and opioid-induced hyperalgesia through activation of N-methyl-D-aspartate receptors. N-methyl-D-aspartate receptor antagonists ketamine and lidocaine can modulate development of opioid tolerance and OIH. This study evaluated the utility of ketamine and/or lidocaine in decreasing opioid consumption during acute pain episodes in adolescents with sickle cell disease. There has been an increased effort to promote opioid-sparing pain relieving methods given the ongoing opioid epidemic. Recent findings There have been six studies published over the past decade that highlight the ability of ketamine to reduce opioid consumption in the management of sickle cell disease-related pain, primarily in adult patients. There has been one study (2015) that demonstrated a similar benefit with lidocaine, however this was also in adult patients. Summary We retrospectively evaluated treatment with ketamine and/or lidocaine infusions in adolescents hospitalized for vaso-occlusive crisis (VOC). Patients served as self-controls using a comparison with a previous control admission for VOC. The use of ketamine and/or lidocaine as adjuncts to opioids resulted in lower daily opioid consumption in three of four patients. Our study suggests that ketamine and/or lidocaine infusions may be useful adjuncts in reducing opioid exposure during VOC pain. Correspondence to Doralina L. Anghelescu, MD, Department of Pediatric Medicine, Division of Anesthesiology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 130, Memphis, TN 38105, USA. Tel: +1 901 595 4032; fax: +1 901 595 4061; e-mail: doralina.anghelescu@stjude.org Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.