Summary
Anorexia and cachexia are major problems in patients with cancer. Such measures as anticancer therapy, dietary counselling or hyperalimentation are not very successful in reversing this phenomenon in the vast majority of cancer patients. Thus, several drugs have been evaluated as agents to ameliorate cancer-associated anorexia/cachexia. Cyproheptadine is an antiserotonergic drug which appears to cause slight appetite stimulation in patients. A randomised clinical trial, however, was unable to demonstrate any weight gain from this agent. Corticosteroids are frequently used in clinical practice for appetite stimulation in patients with advanced malignancies. Supporting this practice, 4 randomised clinical trials showed that corticosteroid medications can stimulate the appetites of advanced cancer patients. However, these studies were not able to show any substantial nonfluid weight gain in treated patients.
Megestrol acetate is a progestational agent which appears to be a relatively potent appetite stimulant. Randomised studies in advanced cancer patients have shown both substantial appetite stimulation and improvement in the nonfluid bodyweights of patients receiving this drug. Preliminary evidence also suggests that this drug has antiemetic properties. Several clinical studies are currently ongoing to determine the effect of various doses of megestrol acetate in patients with cancer.
Efforts are also ongoing to evaluate both anabolic steroids and hydrazine sulfate as drugs for the treatment of patients with cancer anorexia/cachexia. The preliminary nature of these investigations, however, precludes recommendations for the use of either of these latter 2 drugs in routine clinical practice.
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References
Beutler B, Cerami A. Tumor necrosis, cachexia, shock, and inflammation: a common mediator. Annual Review of Biochemistry 57: 505–518, 1988
Bruera E, Macmillan K, Kuehn N, et al. A controlled trial of megestrol acetate on appetite, caloric intake, nutritional status, and other symptoms in patients with advanced cancer. Cancer 66: 1279–1282, 1990
Bruera E, Roca E, Cedaro L, et al. Action of oral methylprednisolone in terminal cancer patients: a prospective randomized double-blind study. Cancer Treatment Reports 69(7): 751–754, 1985
Cavalli F, Goldhirsch A, Jungi F, et al. Randomized trial of low versus high-dose medroxyprogesterone acetate in the induction treatment of postmenopausal patients with advanced breast cancer. Journal of Clinical Oncology 2: 414–418, 1984
Chlebowski RT, Bulcavage L, Grosvenor M, et al. Hydrazine sulfate in cancer patients with weight loss. Cancer 59: 406–410, 1987
Chlebowski RT, Bulcavage L, Grosvenor M, et al. Hydrazine sulfate influence on nutritional status and survival in non-small-cell lung cancer. Journal of Clinical Oncology 8: 9–15, 1990
Chlebowski RT, Heber D, Richardson B, et al. Influence of hydrazine sulfate on abnormal carbohydrate metabolism in cancer patients with weight loss. Cancer Research 44: 857–861, 1984
Chlebowski RT, Herrold J, Ali I, Oktay E, Chlebowski JS, et al. Influence of nandrolone decanoate on weight loss in advanced non-small-cell lung cancer. Cancer 58: 183–186, 1986
DeWys WB, Begg C, Lavin PT, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. American Journal of Medicine 69: 491–497, 1980
Filov VA, Danova LA, Gershanovich ML, et al. Hydrazine sulfate: experimental and clinical results, mechanism of action. In Filov VA et al. (Eds) Medical therapy of tumors, USSR Ministry of Health, pp. 92–139, Leningrad, 1983
Filov VA, Danova LA, Gershanovich ML, et al. Results of clinical evaluation of hydrazine sulfate. Voprosy Onkologii 36: 721–726, 1990
Gershanovich ML, Danova LA, Ivin BA, Filov VA. Results of clinical study of antitumor action of hydrazine sulfate. Nutrition and Cancer 3: 7–12, 1981
Gold J. Proposed treatment of cancer by inhibition of gluconeogenesis. Oncology 22: 185–207, 1968
Gold J. Inhibition by hydralazine sulfate and various hydrazines of in vivo growth of Walker 256 intramuscular carcinoma, Murphy-Sturm lymphosarcoma and L-1210 solid leukemia. Oncology 27: 69–80, 1973
Gold J. 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, 1975
Hall T, Choi O, Abadi A, et al. High dose corticoid therapy in Hodgkin’s disease and other lymphomas. Annals of Internal Medicine 66: 1144, 1967
Hamburger AW, Parnes H, Gordon GB, et al. Megestrol acetate-induced differentiation of 3T3-L1 adipocytes in vitro. Seminars in Oncology 15: 76–78, 1988
Hanks G, Twycross R, Trueman T. Corticosteroids in terminal cancer: a prospective analysis of current practice. Postgraduate Medical Journal 59: 702–706, 1983
Heim W, Wright R, LaLuna F, et al. Adrenal suppressive effect of megestrol acetate in women with metastatic breast carcinoma. Abstract 80. American Society of Clinical Oncology 3: 21, 1984
Holroyde CP, Reichard GA. Carbohydrate metabolism in cancer cachexia. Cancer Treatment Reports 65 (Suppl. 5): 55–59, 1981
Hughes TK, Cadet P, Larned CS. Modulation of tumor necrosis factor activities by a potential anticachexia compound, hydrazine sulfate. International Journal of Immunopharmacology 11: 501–507, 1989
Kardinal CG, Loprinzi CL, Schaid DJ, et al. A controlled trial of cyproheptadine in cancer patients with anorexia and/or cachexia. Cancer 65: 2657–2662, 1990
Klein S, Simes J, Blackburn G. Total parenteral nutrition and cancer clinical trials. Cancer 58: 1378–1386, 1986
Laszlo J. Physicians guide to cancer care complications, pp. 48–52, Marcel Dekker Inc., New York, 1986
Lelli G, Angelelli B, Giambiasi ME, et al. The anabolic effect of high dose medroxyprogesterone acetate in oncology. Pharmacological Research Communications 6: 561–568, 1983
Lerner HJ, Regelson W, Clinical Trial of hydrazine sulfate in solid tumors. Cancer Treatment Reports 60: 959–960, 1976
Loprinzi C, Ellison N. Treatment of cancer anorexia with megestrol acetate: which is the optimal dose? Journal of the National Cancer Institute 83: 450, 1991
Loprinzi CL, Ellison NM, Schaid DJ, et al. Controlled trial of megestrol acetate for the treatment of cancer anorexia and cachexia. Journal of the National Cancer Institute 82: 1127–1132, 1990
Lowry SF, Moldawer LI. Tumor necrosis factor and other cytokines in the pathogenesis of cancer cachexia. In DeVita VT et al. (Eds) Principles and practice of oncology updates, Vol. 4 (8), pp. 1–12, JB Lippincott,4: 8, 1–2, 1990, Philadephia, 1990
Moertel C, Schutt A, Reitmeier R, et al. Corticosteroid therapy of preterminal gastrointestinal cancer. Cancer 33: 1607–1609, 1974
Muss HB, Case LD, Capizzi RL, et al. High-versus standard-dose megestrol acetate in women with advanced breast cancer: a phase III trial of the Piedmont Oncology Association. Journal of Clinical Oncology 8: 1797–1805, 1990
Nemoto T, Patel J, Rosner D, et al. Oral medroxyprogesterone in the treatment of metastatic breast cancer. Journal of Surgical Oncology 32: 211–213, 1986
Nixon DW. The value of parenteral nutritional support. Cancer 58: 1902–1903, 1986
Oschua Jr M, Wittes RE, Krakoff IH. Trial of hydrazine sulfate (NSC-150014) in patients with cancer. Cancer Chemotherapy Reports 59: 1151–1153, 1975
Piantadosi S. Hazards of small clinical trials. Journal of Clinical Oncology 8: 1–3, 1990
Pisters PW, Brennan MF. Amino acid metabolism in human cancer cachexia. Annual Review of Nutrition 10: 107–132, 1990
Popiela T, Lucchi R, Giongo F. Methylprednisolone as palliative therapy for female terminal cancer patients. European Journal of Cancer and Clinical Oncology 25: 1823–1829, 1989
Silverstein R, Bhatia P, Svoboda DJ. Effect of hydrazine sulfate on glucose-regulating enzymes in the normal and cancerous rat. Immunopharmacology 17: 37–53, 1989
Slevin ML, Joel SP, Stubbs L, et al. A randomized double blind placebo controlled trial of medroxyprogesterone acetate (MPA) in cancer cachexia. Proceedings of American Society of Clinical Oncology 7 (March): 238, 1988
Spremulli E, Wampler GL, Regelson W. Clinical study of hydrazine sulfate in advanced cancer patients. Cancer Chemotherapy and Pharmacology 3: 121–124, 1979
Tchekmedyian NS, Hickman M, Siau J, et al. Treatment of cancer anorexia with megestrol acetate: impact on quality of life. Oncology 4(5): 185–192, 1990
Tchekmedyian NS, Tait N, Moody M, et al. Appetite stimulation with megestrol acetate in cachectic cancer patients. Seminars in Oncology 13: 37–43, 1986
Willox J, Corr J, Shaw J, et al. Prednisolone as an appetite stimulant in patients with cancer. British Medical Journal 288: 27, 1984
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Loprinzi, C.L., Goldberg, R.M. & Burnham, N.L. Cancer-Associated Anorexia and Cachexia. Drugs 43, 499–506 (1992). https://doi.org/10.2165/00003495-199243040-00006
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DOI: https://doi.org/10.2165/00003495-199243040-00006