Controlled Trial of Megestrol Acetate for the Treatment of Cancer Anorexia and Cachexia

Abstract

Preliminary information has suggested that megestrol acetate leads to appetite stimulation and nonfluid weight gain in patients with breast cancer, other cancers, and AIDS. Pursuant to this, we developed a randomized, double-blind, placebo-controlled trial of megestrol acetate in patients with cancer-associated anorexia and cachexia. We randomly assigned 133 eligible patients to receive 800 mg of megestrol acetate per day or a placebo. Patients assigned to megestrol acetate more frequently reported improved appetite (P = .003) and food intake (P = .009) when compared with patients receiving the placebo. A weight gain of 15 lb or more over baseline was seen in 11 of 67 (16%) patients receiving megestrol acetate compared with one of 66 (2%) given the placebo (P = .003). Patients receiving megestrol acetate reported significantly less nausea (13% vs. 38%; P = .001) and emesis (8% vs. 25%, P = .009). No clinically or statistically significant toxic reactions were ascribed to megestrol acetate, with the exception of mild edema. This study convincingly demonstrated that megestrol acetate can stimulate appetite and food intake in patients with anorexia and cachexia associated with cancer, leading to significant weight gain in a proportion of such patients.

Selective Inhibition of NF-kappa-B with NBD Peptide Reduces Tumor- Induced Wasting in a Murine Model of Cancer Cachexia In vivo

“…They include mainly appetite stimulants and anabolic agents such as prednisolone [15,51] and progesterone [12,42,43,77] and ghrelin, a ligand which stimulates growth hormone release [44,59]. Anecdotally, the use of α-3 omega fatty acids (eicosapentaenoic acid) [52] and thalidomide (potent anti-TNF activity) have been reported [48].…”

Phase II study of high‐dose fish oil capsules for patients with cancer‐related cachexia

“…Randomized trials have shown weight increases in patients with cancer-associated cachexia who received megestrol acetate. 24,25 However, body composition studies have shown that the weight gain often is related to gains in adipose tissue and water. 26 In contrast, the weight gains observed in patients with pancreatic carcinoma who were treated with omega-3 fatty acids were associated with improvements in lean body mass.…”

Symptom Management in Metastatic Breast Cancer

“…A prospective study of dexamethasone in palliative care demonstrated an improvement in anorexia [88]. Megestrol acetate, at varying doses but usually at 800 mg daily, has been shown to stimulate appetite in patients with cancer [62,89]. The adverse events of adrenal insufficiency and venous thromboembolism should be remembered when prescribing megestrol acetate.…”