Anorexia is often neglected in cancer care, while it contributes to the development of malnutrition and impinges on quality of life. The pathogenesis of cancer anorexia is multifactorial and involves hormones, neuropeptides, cytokines and neurotransmitters. Cytokines play a key role by inhibiting the hypothalamus to appropriately respond to peripheral signals, more specifically by persistently activating anorexigenic systems and/or inhibiting prophagic pathways. Hypothalamic monoaminergic neurotransmission may significantly contribute to these effects. Thus, the optimal therapeutic approach to anorectic cancer patients should be based on both changes in dietary habits, achieved via nutritional counselling, and drug therapy, aimed at interfering with cytokine expression or hypothalamic monoaminergic neurotransmission. © 2005 by The Haworth Press, Inc. All rights reserved.