Abstract
Cancer anorexia/cachexia is a common clinical problem that substantially impacts upon the quality of life and survival of affected patients. Extensive investigations have not supported the use of either enteral or paternal hyperalimentation for such patients. Despite positive pilot trial reports, large randomized studies have been unable to demonstrate a clinically defensible role for either pentoxifylline, cyproheptadine, or hydrazine sulfate for patients with anorexia. Multiple placebo-controlled, randomized, double-blind, clinical trials have demonstrated that corticosteroids do have appetite-enhancing properties in patients suffering from cancer anorexia/cachexia, but none of these studies has demonstrated weight gain. In comparison, multiple studies have demonstrated that the progestational agent, megestrol acetate, has both appetite-enhancing and weight-promoting properties.
Similar content being viewed by others
References
Bruera E (1992) Current pharmacological management of anorexia in cancer patients. Oncology 6:125–130
Bruera E, Roca E, Cedaro L, et al (1985) Action of oral methylprednisolone in terminal cancer patients: a prospective randomized double-blind study. Cancer Treat Rep 69:751–754
Bruera E, Macmillan K, Kuehn N, et al (1990) A controlled trial of megestrol acetate on appetite, caloric intake, nutritional status, and other symptoms in patients with advanced cancer. Cancer 66: 1279–1282
Chlebowski RT, Heber D, Richardson B, et al (1984) Influence of hydrazine sulfate on abnormal carbohydrate metabolism in cancer patients with weight loss. Cancer Res 44:857–861
Chlebowski RT, Herrold J, Ali I, Oktay E, Chlebowski JS, et al (1986) Influence of nandrolone decanoate on weight loss in advanced non-small cell lung cancer. Cancer 58:183–186
Chlebowski RT, Bulcavage L, Grosvenor M, et al (1987) Hydrazine sulfate in cancer patients with weight loss. Cancer 59:406–410
Chlebowski RT, Bulcavage L, Grosvenor M, et al (1990) Hydrazine sulfate influence on nutritional status and survival in non-small cell lung cancer. J Clin Oncol 8:9–15
DeWys WB, Begg C, Lavin PT, et al (1980) Prognostic effect of weight loss prior to chemotherapy in cancer patients. Am J Med 69:491–497
Dezube BJ, Fridovbich-Keil JL, Bouvard I, Lange RF, Pardee AB (1990) Pentoxifylline and wellbeing in patients with cancer. Lancet I 335:662
Fazely F, Dezube BJ, Allen-Ryan J, Pardee AB, Ruprecht RM (1991) Pentoxifylline (Trental) decreases the replication of the human immunodeficiency virus type 1 in human peripheral blood mononuclear cells and in cultured T cells. Blood 77:1653–1656
Feliu J, Gonzalez-Baron M, Berrocal A, et al (1991) Treatment of cancer anorexia with megestrol acetate: which is the optimal dose? J Natl Cancer Inst 83:449
Filov VA, Danova LA, Gershanovich ML, et al (1990) Results of clinical evaluation of hydrazine sulfate. Vopr Onkol 36:721–726
Freed DJ, Banks AJ, Longson D, Burley DM (1975) Anabolic steroids in athletics: crossover double-blind trial on weightlifters. Br Med J 5:471–473
Gold J (1975) Use of hydrazine sulfate in terminal and preterminal cancer patients: results of investigational new drug (IND) study in 84 evaluable patients. Oncology 32:1–10
Goldberg RM, Loprinzi CL, Mailliard J, O'Fallon JR (1994) A randomized, placebo-controlled evaluation of pentoxifylline in patients with cancer anorexia and cachexia. A North Central Cancer Treatment Group Study. Proc Am Soc Clin Oncol 13:459
Kardinal CG, Loprinzi CL, Schaid DJ, et al (1990) A controlled trial of cyproheptadine in cancer patients with anorexia and/or cachexia. Cancer 65:2657–2662
Klein S, Simes J, Blockburn G (1986) Total parenteral nutrition and cancer clinical trials. Cancer 58:1378–1386
Kosty M, Fleishman S, Herndon J, Coughlin K, et al (1992) Cisplatin, vinblastine and hydrazine sulfate (NSC #150014) in advanced nonsmall lung cancer (NSCLC): a randomized, placebo-controlled, doubleblind phase III study. Proc Am Soc Clin Oncol 11:294
Lamb DR (1984) Anabolic steroids in athletics: how well do they work and how dangerous are they? Am J Sports Med 12:31–38
Lelli G, Angelelli B, Giambiasi ME, et al (1983) The anabolic effect of high dose medroxyprogesterone acetate in oncology. Pharmacol Res Commun 6:561–568
Loprinzi CL, Ellison NM (1991) Treatment of cancer anorexia with megestrol acetate: which is the optimal dose? J Natl Cancer Inst 83:450
Loprinzi CL, Ellison NM, Schaid DJ, et al (1990) Controlled trial of megestrol acetate for the treatment of cancer anorexia and cachexia. J Natl Cancer Inst 82:1127–1132
Loprinzi CL, Jensen MD, Jiang NS, Schaid DJ (1992) The effect of megestrol acetate on the human pituityadrenal axis. Mayo Clin Proc 67:1160–1162
Loprinzi CL, Schaid DJ, Dose AM, Burnham NL, Jensen MD (1992) Body composition changes in patients who gain weight while receiving megestrol acetate. J Clin Oncol 11:152–154
Loprinzi C, Johnson P, Jensen M (1992) Megestrol acetate for anorexia and cachexia. Oncology 49 [Suppl 2]:46–49
Loprinzi CL, Michalak JC, Schaid DJ, Mailliard JA, Athmann LH, Goldberg RM, Tschetter LK, Hatfield AK, Morton RF (1993) Phase III evaluation of four doses of megestrol acetate as therapy for patients with cancer anorexia and/or cachexia. J Clin Oncol 11:762–767
Loprinzi CL, Kuross SA, O'Fallon JR, Gesme DH, Gerstner JB, Rospond RM, Cobau CD, Goldberg RM (1994) Randomized, placebo-controlled evaluation of hydrazine sulfate in patients with advanced colorectal cancer. J Clin Oncol 12:1121–1125
Loprinzi CL, Goldberg RG, Su JQ, Mailliard J, Maksymiuk A, Kugler J, Jett J, Ghosh C, Pfeifle D, Wender D, Burch P (1994) Placebo-controlled trial of hydrazine sulfate in patients with newly diagnosed non-small cell lung cancer. J Clin Oncol 12:1126–1129
Moertel CG, Schutt AJ, Reitemeier RJ, Hahn RG (1974) Corticosteroid therapy of preterminal gastrointestinal cancer. Cancer 33:1607–1609
Nixon DW (1986) The value of parenteral nutritional support. Cancer 58:1902–1903
Ota DM, Copeland MD, Strobel HE, et al (1977) The effect of protein nutrition on host and tumor metabolism. J Surg Res 22:181–188
Piantadosi S (1990) Hazards of small clinical trials. J Clin Oncol 8:1–3
Popiela T, Lucchi R, Giongo F (1989) Methylprednisolone as palliative therapy for female terminal cancer patients. Eur J Cancer Clin Oncol 25:1823–1829
Popp MD, Wagner SC, Brito OJ (1983) Host and tumor responses to increasing levels of intravenous nutritional support. Surgery 94:300–308
Popp MD, Kirkemo AK, Morrison SD, Brennen MF (1984) Tumor and host carcass changes during total parenteral nutrition in an anorectic rattumor system. Ann Surg 199:205–210
Slevin ML, Joel SP, Stubbs L, et al (1988) A randomized double-blind placebo-controlled trial of medroxyprogesterone acetate (MPA) in cancer cachexia. Proc Am Soc Clin Oncol 7:238
Steiger E, Oram-Smith J, Miller E, Kuol, Vars HM (1975) Effect of nutrition on tumor growth and tolerance of chemotherapy J Surg Res 18:455–461
Tahmindjis AJ (1976) The use of anabolic steroids by athletes to increase body weight and strength. Med J Aust 1:991–993
Tchekmedyian NS, Hickman M, Siau J, Greco FA, Keller J, Browder H, Aisner J (1992) Megestrol acetate in cancer anorexia and weight loss. Cancer 69:1268–1274
Warren S (1932) The immediate cause of death in cancer. Am J Med Sci 184:610–615
Wilcox J, Corr J, Shaw J, et al (1984) Prednisolone as an appetite stimulant in patients with cancer. Br Med J 288:27
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Loprinzi, C.L. Management of cancer anorexia/cachexia. Support Care Cancer 3, 120–122 (1995). https://doi.org/10.1007/BF00365851
Issue Date:
DOI: https://doi.org/10.1007/BF00365851