From the Guidelines
Selective androgen receptor modulators (SARMs) should not be used in clinical practice for cancer patients due to their experimental nature and lack of FDA approval, as well as potential adverse effects such as liver toxicity and hormonal disruption 1.
Current Status of SARMs
SARMs are small non-steroid molecules designed to selectively activate the skeletal muscle androgen receptor, potentially avoiding the adverse side effects of naturally occurring androgenic steroids. However, these substances are in early phase clinical trials and none have received approval for treatment in a cancer setting 1.
Potential Benefits and Risks
In a phase 2 trial, the first-in-class agent, enobosarm, showed increased lean body mass as well as increased power and speed on a stair climbing test 1. Despite this, SARMs can still cause significant adverse effects, and their long-term safety profile remains largely unknown, making their unsupervised use particularly risky.
Comparison to Other Treatments
Typical representatives of androgens investigated in cancer patients include nandrolone decanoate and oral oxandrolone or fluoxymesterone, which have shown some benefits in terms of weight loss and appetite stimulation 1. However, SARMs are not a recommended treatment option at this time due to their experimental status and potential risks.
Clinical Implications
Given the lack of strong evidence supporting the use of SARMs in cancer patients, and considering the potential risks associated with their use, it is recommended that SARMs not be used in clinical practice for cancer patients outside of controlled clinical trials 1. Instead, other treatments such as nandrolone decanoate or oxandrolone may be considered, under the guidance of a healthcare professional.
From the Research
Definition and Mechanism of Selective Androgen Receptor Modulators
- Selective androgen receptor modulators (SARMs) are a class of androgen receptor ligands that bind androgen receptors and display tissue-selective activation of androgenic signaling 2.
- SARMs have selective anabolic effects on muscle and bone, and were originally synthesized for treatment of muscle wasting conditions, osteoporosis, and breast cancer 2, 3.
- The development and potential clinical use of tissue-selective androgen receptor modulators (SARMs) have advanced tremendously over the past few years, providing therapeutic opportunities in a variety of diseases 4.
Potential Clinical Applications
- SARMs have been studied as possible therapies for many conditions, including osteoporosis, Alzheimer's disease, breast cancer, stress urinary incontinence (SUI), prostate cancer (PCa), benign prostatic hyperplasia (BPH), male contraception, hypogonadism, Duchenne muscular dystrophy (DMD), and sarcopenia/muscle wasting/cancer cachexia 3.
- SARMs have numerous possible clinical applications, with promise for the safe use in the treatment of cachexia, BPH, hypogonadism, breast cancer, and prostate cancer 5.
- Early clinical studies have demonstrated potential uses for SARMs in the treatment of cancer-related cachexia, benign prostatic hyperplasia (BPH), hypogonadism, and breast cancer, with positive results 5.
Adverse Effects and Safety
- More than half of SARMs users experienced side effects including mood swings, decreased testicular size, and acne 2.
- Despite having seemingly positive effects, more than 50% of SARMs users report significant adverse effects 2.
- The adverse effects of SARMs usage, including its potential effects on fertility, have not been explored, and further investigation is necessary 6.