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431 Summarizing discussion and future perspectives status by mechanisms including proteolysis and lipolysis. 28 The current strategies in clinical practice to combat metabolic disorders in head and neck cancer patients generally focus on weight maintenance whereby patients are encouraged to eat as many calories as possible and when they experience swallowing problems calories are supplemented either by oral or parenteral nutrition. However, due to the various mechanisms that causemalnutrition and the accompanying loss of skeletal muscle mass in patients with head and neck cancer, reversing malnutrition is not simple done by stimulating caloric intake. Because of heterogeneity of body composition types in head and neck cancer, nutritional support must be personalized to the individual needs. This personalized approach can be supported by measurement of patients’ resting energy expenditure by a caloric meter, this provides information about the amount of calories a patient need. Besides caloric supplementation, protein supplementa - tion should play a major role in reversing malnutrition in head and neck cancer. Increasing evidence suggests that protein intake should consist of a daily intake of 1.5-2/kg/day in order to increase muscle protein synthesis and reduce proteolysis. 29 Nutritional supplements are also under investigation for the treatment of low skeletal muscle mass. For surgically treated head and neck cancer patients, supplementation with eicosapentaenoic acid (EPA), which is analpha-3-omega fatty acid found in fish oil, showed short-term benefit in combatting loss of muscle mass, however long-term follow-up is needed. 30 PHARMACOLOGICAL INTERVENTION Drugs that target overactivation of catabolic processes, cell injury and inflammation are prom- ising in the field of combatting muscle mass loss. Drugs that exhibit these characteristics are selective androgen receptor modulators, anti-inflammatory drugs such as anti-cytokine agents or ghreline analogues. 31,32 Ghrelin is hormone secreted by the stomach that stimulates appetite andmuscle anabolism. 33 Anamoreline, a ghrelin analogue, has been investigated in a randomized controlled trial in >450 cachectic patients with advanced lung cancer. 32 Patients who received anamoreline for 12 weeks showed a significant increase in muscle mass and patients that had increasedmusclemass also showed a significantly increased overall survival from9 to 13months. Because of the role of inflammation inmuscle wasting, anti-inflammatory drugs may be promising in counteracting muscle loss. Randomized controlled trials investi - gating the role of anti-inflammatory drugs such as tocilizumab (anti-Il-6-receptor antibody), infliximab (anti-tumor necrosis factor (TNF)-alpha agent) and canakinumab (anti-IL-1 antibody) in the prevention of skeletal muscle mass loss in head and neck cancer patients are needed. Previous studies in patients with rheumatoid arthritis showed that treatment with tocilizum- ab lead to gain in skeletal muscle mass. 34 This anabolic effect of tocilizumab has also been in shown in a patient with lung cancer. 35 ADDITIONAL REMARK: THE ROLE OF ARTIFICIAL INTELLIGENCE In order to facilitate implementation of skeletal musclemass as a biomarker in clinical practice, it is of outmost importance to improve speed efficiency in measurements. Speed efficiency in image analysis can be performed by use of artificial intelligence (AI) such as deep learning and machine learning. Research on the role of AI in body compositionmeasurements is increasing. 21