Joanna Bowden

Project Title

Investigating novel therapeutics for cancer cachexia.

Project summary

Cachexia is a prevalent and highly debilitating condition experienced by patients with a range of malignant and non-malignant diseases. It is a multifactorial metabolic syndrome characterised by loss of skeletal muscle that cannot be reversed by simple nutritional support. It is invariably associated with fatigue, low mood, poor quality of life and poor survival. Patients with cancer and cachexia are less likely to be fit for systemic disease-modifying treatment that would otherwise have the potential to improve their symptoms and survival.

Our understanding of the pathophysiology of cachexia has progressed significantly in recent years and this has opened up a number of potential avenues for different treatment modalities.

One such avenue involves the protein myostatin, which inhibits skeletal muscle growth via the ACTRIIB receptor. Monoclonal antibodies to myostatin have been developed, with the idea that blocking its action may have positive consequences in terms of muscle growth in patients with cancer cachexia.

My current role is to coordinate the Edinburgh site for two multicentre RCTs investigating different monoclonal antibody treatments for patients with lung or pancreatic cancer. This involves working with the Wellcome Trust research team and the oncology teams at the Western General Hospital to identify potential patients and to support participants through the studies. My clinical background as a consultant in palliative medicine has been invaluable for this role as the participants have advanced disease and often established cachexia. It has meant that I’ve been able to identify and initiate management for patients’ complex medical and psychosocial needs as they progress through the studies, which has involved working closely with oncology, wider palliative care services in Edinburgh and Fife and patients’ primary care teams. Through screening and recruitment activity we have begun to learn more about the wider clinical picture of patients with cancer cachexia. In particular we have been interested to investigate the role that comorbidity plays in both the development of cachexia and the experience of living with the condition. Comorbidity, like cachexia, is an independent predictor of poor survival in patients with cancer, and there is much still to learn about the potential interrelationship.

I hope to secure funding through a fellowship in the next year to undertake a higher degree to investigate these clinically important areas further.

Funding

Acacia

Supervisor

Professor K Fearon

Qualifications

• Masters in Clinical Education (with merit) 2012
• MRCP 2005
• MBChB 2002