Dronabinol Versus Megestrol Acetate Versus Combination Therapy for Cancer-Associated Anorexia: A North Central Cancer Treatment Group Study

Jatoi, Aminah; Windschitl, Harold E.; Loprinzi, Charles L.; Sloan, Jeff A.; Dakhil, Shaker R.; Mailliard, James A.; Pundaleeka, Sarode; Kardinal, Carl G.; Fitch, Tom R.; Krook, James E.; Novotny, Paul J.; Christensen, Brad

doi:10.1200/jco.2002.20.2.567

Cited by 300 publications

(160 citation statements)

References 20 publications

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Section: Introductionmentioning

confidence: 99%

“…The most common prodromal finding in patients with cancer, occurring in 31-37% [1][2][3], is weight loss. Greatest losses are seen in patients with cancer of the upper gastrointestinal tract [1,2]. Cytokine-mediated cachexia and side effects of toxicities of antineoplastic therapy can further exacerbate the existing involuntary weight loss [1,2,[4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Retracted: Early supplementation of parenteral nutrition is capable of improving quality of life, chemotherapy‐related toxicity and body composition in patients with advanced colorectal carcinoma undergoing palliative treatment: results from a prospective, randomized clinical trial

Hasenberg

Essenbreis

Herold³

et al. 2009

Colorectal Disease

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Aim Patients suffering from advanced colorectal cancer can experience unintended weight loss and/or treatment‐induced gastrointestinal toxicity. Based on current evidence, the routine use of parenteral nutrition (PN) for patients with colorectal cancer is not recommended. This study evaluates the effect of PN supplementation on body composition, quality of life (QoL), chemotherapy‐associated side effects and survival in patients with advanced colorectal cancer. Method Eighty‐two patients with advanced colorectal cancer receiving a palliative chemotherapy were prospectively randomized to either oral enteral nutrition supplement (PN‐) or oral enteral nutrition supplement plus supplemental PN (PN+). Every 6 weeks body weight, body mass index (BMI), chemotherapy‐associated side effects and caloric intake were assessed, haemoglobin and serum albumin were measured. Body composition was assessed by body impedance analysis, and QoL was evaluated by European Organization for Research and Treatment of Cancer (EORTC) QLQC30 questionnaire. Results No differences were evident at baseline between the groups for age, sex, diagnosis, weight, BMI or QoL. A difference in BMI was observed by week 36, whereas differences of the mean body cell mass could be observed from week 6, albumin dropped significantly in the PN‐ group in week 36 and QoL showed significant differences from week 18. Chemotherapy‐associated side effects were higher in PN‐. The survival rate was significantly greater in the PN+ group. Conclusion A supplementation with PN slows weight loss, stabilizes body‐composition and improves QoL in patients with advanced colorectal cancer. Furthermore, it can reduce chemotherapy‐related side effects.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Retracted: Early supplementation of parenteral nutrition is capable of improving quality of life, chemotherapy‐related toxicity and body composition in patients with advanced colorectal carcinoma undergoing palliative treatment: results from a prospective, randomized clinical trial

Hasenberg

Essenbreis

Herold³

et al. 2009

Colorectal Disease

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“…THC is effective in AIDS wasting and cancer cachexia [247]. THC (2 x 2.5 mg) was less effective than megestrol acetate (800 mg daily).…”

Section: Established Effectsmentioning

confidence: 99%

Cannabinoids

Grotenhermen

2005

CDTCNSND

110

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Since the discovery of an endogenous cannabinoid system, research into the pharmacology and therapeutic potential of cannabinoids has steadily increased. Two subtypes of G-protein coupled cannabinoid receptors, CB(1) and CB(1), have been cloned and several putative endogenous ligands (endocannabinoids) have been detected during the past 15 years. The main endocannabinoids are arachidonoyl ethanolamide (anandamide) and 2-arachidonoyl glycerol (2-AG), derivatives of arachidonic acid, that are produced "on demand" by cleavage of membrane lipid precursors. Besides phytocannabinoids of the cannabis plant, modulators of the cannabinoid system comprise synthetic agonists and antagonists at the CB receptors and inhibitors of endocannabinoid degradation. Cannabinoid receptors are distributed in the central nervous system and many peripheral tissues, including immune system, reproductive and gastrointestinal tracts, sympathetic ganglia, endocrine glands, arteries, lung and heart. There is evidence for some non-receptor dependent mechanisms of cannabinoids and for endocannabinoid effects mediated by vanilloid receptors. Properties of CB receptor agonists that are of therapeutic interest include analgesia, muscle relaxation, immunosuppression, anti-inflammation, antiallergic effects, improvement of mood, stimulation of appetite, antiemesis, lowering of intraocular pressure, bronchodilation, neuroprotection and antineoplastic effects. The current main focus of clinical research is their efficacy in chronic pain and neurological disorders. CB receptor antagonists are under investigation for medical use in obesity and nicotine addiction. Additional potential was proposed for the treatment of alcohol and heroine dependency, schizophrenia, conditions with lowered blood pressure, Parkinson's disease and memory impairment in Alzheimer's disease.

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“…56,57 In multiple randomized comparison studies, megestrol acetate and synthetic tetrahydrocannabinol have been shown to be useful appetite stimulants. 58,59 In a randomized, double-blind, placebo-controlled study, patients with advanced cancer who received dronabinol had increased appetite, appreciation for food, protein consumption, and total caloric intake, as well as quality of sleep, relaxation, and QoL. 60 Similar results were seen in a 2018 study with nabilone.…”

Section: Pancreatic Cancer-related Symptom Managementmentioning

confidence: 73%

Pancreatic cancer—A disease in need: Optimizing and integrating supportive care

Moffat

Epstein

O’Reilly

2019

Cancer

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Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy that continues to be challenging to treat. PDAC has the lowest 5‐year relative survival rate compared with all other solid tumor malignancies and is expected to become the second‐leading cause of cancer‐related death in the United States by 2030. Given the high mortality, there is an increasing role for concurrent anticancer and supportive care in the management of patients with PDAC with the aims of maximizing length of life, quality of life, and symptom control. Emerging trends in supportive care that can be integrated into the clinical management of patients with PDAC include standardized supportive care screening, early integration of supportive care into routine cancer care, early implementation of outpatient‐based advance care planning, and utilization of electronic patient‐reported outcomes for improved symptom management and quality of life. The most common symptoms experienced are nausea, constipation, weight loss, diarrhea, anorexia, and abdominal and back pain. This review article includes current supportive management strategies for these and others. Common disease‐related complications include biliary and duodenal obstruction requiring endoscopic procedures and venous thromboembolic events. Patients with PDAC continue to have a poor prognosis. Systemic therapy options are able to palliate the high symptom burden but have a modest impact on overall survival. Early integration of supportive care can lead to improved outcomes.

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Dronabinol Versus Megestrol Acetate Versus Combination Therapy for Cancer-Associated Anorexia: A North Central Cancer Treatment Group Study

Abstract: In the doses and schedules we studied, megestrol acetate provided superior anorexia palliation among advanced cancer patients compared with dronabinol alone. Combination therapy did not appear to confer additional benefit.

Cited by 300 publications

References 20 publications

Retracted: Early supplementation of parenteral nutrition is capable of improving quality of life, chemotherapy‐related toxicity and body composition in patients with advanced colorectal carcinoma undergoing palliative treatment: results from a prospective, randomized clinical trial

Retracted: Early supplementation of parenteral nutrition is capable of improving quality of life, chemotherapy‐related toxicity and body composition in patients with advanced colorectal carcinoma undergoing palliative treatment: results from a prospective, randomized clinical trial

Cannabinoids

Pancreatic cancer—A disease in need: Optimizing and integrating supportive care

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