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Understanding sex differences in the regulation of cancer-induced muscle wasting

Montalvo, Ryan N.; Counts, Brittany R.; Carson, James A.

Current Opinion in Supportive and Palliative Care: December 2018 - Volume 12 - Issue 4 - p 394–403
doi: 10.1097/SPC.0000000000000380
CACHEXIA, NUTRITION AND HYDRATION: Edited by Aminah Jatoi and Barry J.A. Laird

Purpose of review We highlight evidence for sexual dimorphism in preclinical and clinical studies investigating the cause and treatment of cancer cachexia.

Recent findings Cancer cachexia is unintended bodyweight loss occurring with cancer, and skeletal muscle wasting is a critical predictor of negative outcomes in the cancer patient. Skeletal muscle exhibits sexual dimorphism in fiber type, function, and regeneration capacity. Sex differences have been implicated in skeletal muscle metabolism, mitochondrial function, immune response to injury, and myogenic stem cell regulation. All of these processes have the potential to be involved in cancer-induced muscle wasting. Unfortunately, the vast majority of published studies examining cancer cachexia in preclinical models or cancer patients either have not accounted for sex in their design or have exclusively studied males. Preclinical studies have established that ovarian function and estradiol can affect skeletal muscle function, metabolism and mass; ovarian function has also been implicated in the sensitivity of circulating inflammatory cytokines and the progression of cachexia.

Summary Females and males have unique characteristics that effect skeletal muscle's microenvironment and intrinsic signaling. These differences provide a strong rationale for distinct causes for cancer cachexia development and treatment in males and females.

Department of Exercise Science, University of South Carolina, Public Health Research Center, Columbia, USA

Correspondence to James A. Carson, PhD, Professor & Chair, Department of Exercise Science University of South Carolina, 921 Assembly Street, Public Health Research Center, Room 301, Columbia, SC 29208, USA. Tel: +1 803 777 2185; e-mail:

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