Randomized double-blind placebo-controlled trial of cisplatin and etoposide plus megestrol acetate/placebo in extensive-stage small-cell lung cancer: a North Central Cancer Treatment Group study.

Abstract

Megestrol acetate cannot be routinely recommended for all patients with small-cell lung cancer at the time of chemotherapy initiation. Rather, its therapeutic ratio may be more favorable for patients with problematic cancer anorexia/cachexia.

Results of a phase III, double-blind, placebo-controlled trial of megestrol acetate modulation of P-glycoprotein-mediated drug resistance in the first-line management of small-cell lung carcinoma

“…A recent published randomized trial prescribed MA at 800 mg per day starting 3-5 days after chemotherapy for 3-4 weeks until the next course of the planned four courses and then for a total of 2 years in advanced SCLC patients. Even with this higher dose and prolonged course, no difference in response rates or survival was seen compared with placebo (Rowland et al, 1996). Our dose was chosen for potential efficacy while minimizing risk of thromboembolic complications, but perhaps a higher dose would have led to different results.…”

Mechanisms of Cancer Cachexia

“…Thus activation of PKR will lead to phosphorylation of eIF2 on the ␣-subunit, inhibiting translation initiation (217). In addition, activation of PKR leads to an increased expression and activity of the ubiquitinproteasome pathway, through activation of NFB, either by direct interaction or through formation of ROS (66).…”

“…The inability of megestrol acetate to cause accretion of lean body mass would explain why patients show no significant improvement in the Karnovsky index (performance score) or quality of life. Despite its widespread use, patients receiving megestrol acetate show an increase in thromboembolic phenomena, more edema, an inferior response rate to chemotherapy, and a trend for inferior survival duration (217).…”

Serotonergic blockade in the treatment of the cancer anorexia‐cachexia syndrome

“…10 Unfortunately, the weight gained primarily is fluid and fat (not muscle mass) and when added to standard chemotherapy for small cell lung carcinoma does not result in improvement in terms of response, survival, or quality of life. 11,12 In addition, adrenal suppression has been reported with this agent. 13 A recent study of megestrol acetate did demonstrate significant improvement in both appetite and quality of life in patients with advanced hormone-insensitive cancer.…”