“She was getting increasingly less interested in things: reading her favourite books, listening to music, watching television,” he recalls. Eventually, she said: “My body is used up, and I have no will left to live.”
Janowitz, a biochemist at Cold Spring Harbour Laboratory in the US, approached this decline differently. Rather than seeing it as an inevitable consequence of the disease, he was already researching ways to treat the apathy and wasting, known medically as cachexia, to improve patients’ quality of life and potentially extend survival.
While drugs such as Ozempic are designed to suppress appetite, Janowitz’s work focuses on doing the opposite: boosting appetite and, metaphorically, the “appetite for life.”
Cachexia is not unique to cancer. It was common in early AIDS patients and those with tuberculosis, historically referred to as consumption. Janowitz warns against assuming that this wasting is just part of the disease. “It is a profoundly disabling condition, and it reduces resilience against treatment,” he explains.
Cancer Research UK has funded Janowitz and his team through a Cancer Grand Challenge to investigate the biological causes of cachexia and explore potential treatments. Part of their mission is to raise awareness among clinicians, who often view it as an unavoidable final stage rather than a treatable condition.
Janowitz emphasises:
“It is actually a condition independent of the tumour, even though it’s caused by the tumour. If we understand the molecular processes that drive it, we can hope to start preventing it from occurring.”
Even mild cases of cachexia may feel familiar. A serious flu can cause loss of appetite, fatigue and a withdrawal from normal activities. Evolution may have developed this response to limit the spread of infection or starve pathogens. However, with cancer, the same response becomes chronic and harmful.
Janowitz’s research has highlighted one potential mechanism: an immune protein called interleukin-6, which may signal the brain to induce apathetic behaviour and suppress appetite. By targeting this pathway, scientists hope to reduce suffering, much like how pain relief is routinely used, and potentially prolong patients’ survival.
He explains the ultimate challenge:
“With chemotherapy I could kill any tumour. The challenge is to not kill the organism, to keep the patient alive. You can’t do that if a patient is starving. Most cancer therapies make people feel worse. We are hoping that the interventions we propose can do the reverse.”
By tackling cachexia, Janowitz and his team aim not only to ease suffering but also to support patients’ resilience against the disease, potentially transforming how cancer care addresses this often-overlooked condition.
