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Clinical implication of megestrol acetate in metastatic gastric cancer: a big data analysis from Health Insurance Review and Assessment (HIRA) database

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Abstract

Objective

Megestrol acetate (MA) is used to manage anorexia and cachexia in patients with advanced cancer. This study investigated the prescription patterns of MA in patients with metastatic gastric cancer, as well as evaluated its impact on survival outcomes and the incidence of venous thromboembolism (VTE).

Methods

A Health Insurance Review and Assessment (HIRA) service database was used to investigate differences in baseline characteristics, survival, and the incidence of VTE according to MA prescription patterns (i.e., prescription vs. no prescription) in patients diagnosed with metastatic gastric cancer from July 2014 to December 2015.

Results

A total of 1938 patients were included in this study. In total, 65% of the patients were prescribed MA. Older age, treatment in tertiary hospitals, and palliative chemotherapy were statistically significant predictive factors for MA prescription. Continuous prescription of MA was observed in 37% of patients. There was no statistically significant difference in survival between the MA and non-MA prescription groups on multivariate analysis. Among the 1427 patients included in the analysis for VTE incidence, 4.3% and 2.9% were diagnosed with VTE during the follow-up period in the MA and non-MA prescription groups, respectively. However, there was no statistically significant difference in VTE diagnosis between the groups on multivariate analysis.

Conclusion

MA is commonly prescribed for metastatic gastric cancer, especially in elderly patients and those undergoing palliative chemotherapy, without significantly affecting survival or VTE risk.

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Data availability

The data are not publicly available due to institutional (HIRA) policy.

Code availability

Not available.

References

  1. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL et al (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12(5):489–495

    Article  PubMed  Google Scholar 

  2. Go SI, Park MJ, Park S, Kang MH, Kim HG, Kang JH et al (2021) Cachexia index as a potential biomarker for cancer cachexia and a prognostic indicator in diffuse large B-cell lymphoma. J Cachexia Sarcopenia Muscle 12(6):2211–2219

    Article  PubMed  PubMed Central  Google Scholar 

  3. Moses AW, Slater C, Preston T, Barber MD, Fearon KC (2004) Reduced total energy expenditure and physical activity in cachectic patients with pancreatic cancer can be modulated by an energy and protein dense oral supplement enriched with n-3 fatty acids. Br J Cancer 90(5):996–1002

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Srdic D, Plestina S, Sverko-Peternac A, Nikolac N, Simundic AM, Samarzija M (2016) Cancer cachexia, sarcopenia and biochemical markers in patients with advanced non-small cell lung cancer-chemotherapy toxicity and prognostic value. Support Care Cancer 24(11):4495–4502

    Article  PubMed  Google Scholar 

  5. Sun L, Quan XQ, Yu S (2015) An epidemiological survey of cachexia in advanced cancer patients and analysis on its diagnostic and treatment status. Nutr Cancer 67(7):1056–1062

    Article  PubMed  Google Scholar 

  6. Poisson J, Martinez-Tapia C, Heitz D, Geiss R, Albrand G, Falandry C et al (2021) Prevalence and prognostic impact of cachexia among older patients with cancer: a nationwide cross-sectional survey (NutriAgeCancer). J Cachexia Sarcopenia Muscle 12(6):1477–1488

    Article  PubMed  PubMed Central  Google Scholar 

  7. Fujii H, Makiyama A, Iihara H, Okumura N, Yamamoto S, Imai T et al (2020) Cancer cachexia reduces the efficacy of nivolumab treatment in patients with advanced gastric cancer. Anticancer Res 40(12):7067–7075

    Article  CAS  PubMed  Google Scholar 

  8. Namikawa T, Marui A, Yokota K, Fujieda Y, Munekage M, Uemura S et al (2022) Frequency and prognostic impact of cachexia during drug treatment for unresectable advanced gastric cancer patients. Surg Today 52(11):1560–1567

    Article  CAS  PubMed  Google Scholar 

  9. Churm D, Andrew IM, Holden K, Hildreth AJ, Hawkins C (2009) A questionnaire study of the approach to the anorexia-cachexia syndrome in patients with cancer by staff in a district general hospital. Support Care Cancer 17(5):503–507

    Article  PubMed  Google Scholar 

  10. Arends J, Strasser F, Gonella S, Solheim TS, Madeddu C, Ravasco P et al (2021) Cancer cachexia in adult patients: ESMO Clinical Practice Guidelines(). ESMO Open 6(3):100092

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Argiles JM, Anguera A, Stemmler B (2013) A new look at an old drug for the treatment of cancer cachexia: megestrol acetate. Clin Nutr 32(3):319–324

    Article  CAS  PubMed  Google Scholar 

  12. McCarthy HD, Crowder RE, Dryden S, Williams G (1994) Megestrol acetate stimulates food and water intake in the rat: effects on regional hypothalamic neuropeptide Y concentrations. Eur J Pharmacol 265(1–2):99–102

    Article  CAS  PubMed  Google Scholar 

  13. Mantovani G, Maccio A, Esu S, Lai P, Santona MC, Massa E et al (1997) Medroxyprogesterone acetate reduces the in vitro production of cytokines and serotonin involved in anorexia/cachexia and emesis by peripheral blood mononuclear cells of cancer patients. Eur J Cancer 33(4):602–607

    Article  CAS  PubMed  Google Scholar 

  14. Mantovani G, Maccio A, Lai P, Massa E, Ghiani M, Santona MC (1998) Cytokine involvement in cancer anorexia/cachexia: role of megestrol acetate and medroxyprogesterone acetate on cytokine downregulation and improvement of clinical symptoms. Crit Rev Oncog 9(2):99–106

    Article  CAS  PubMed  Google Scholar 

  15. De Conno F, Martini C, Zecca E, Balzarini A, Venturino P, Groff L et al (1998) Megestrol acetate for anorexia in patients with far-advanced cancer: a double-blind controlled clinical trial. Eur J Cancer 34(11):1705–1709

    Article  PubMed  Google Scholar 

  16. Bruera E, Ernst S, Hagen N, Spachynski K, Belzile M, Hanson J et al (1998) Effectiveness of megestrol acetate in patients with advanced cancer: a randomized, double-blind, crossover study. Cancer Prev Control 2(2):74–78

    CAS  PubMed  Google Scholar 

  17. Loprinzi CL, Michalak JC, Schaid DJ, Mailliard JA, Athmann LM, Goldberg RM et al (1993) Phase III evaluation of four doses of megestrol acetate as therapy for patients with cancer anorexia and/or cachexia. J Clin Oncol 11(4):762–767

    Article  CAS  PubMed  Google Scholar 

  18. Jatoi A, Rowland K, Loprinzi CL, Sloan JA, Dakhil SR, MacDonald N et al (2004) An eicosapentaenoic acid supplement versus megestrol acetate versus both for patients with cancer-associated wasting: a North Central Cancer Treatment Group and National Cancer Institute of Canada collaborative effort. J Clin Oncol 22(12):2469–2476

    Article  CAS  PubMed  Google Scholar 

  19. López AP, i Figuls MR, Cuchi GU, Berenstein EG, Pasies BA, Alegre MB et al (2004) Systematic review of megestrol acetate in the treatment of anorexia-cachexia syndrome. J Pain Symptom Manage 27(4):360–369

    Article  Google Scholar 

  20. Kouchaki B, Janbabai G, Alipour A, Ala S, Borhani S, Salehifar E (2018) Randomized double-blind clinical trial of combined treatment with megestrol acetate plus celecoxib versus megestrol acetate alone in cachexia-anorexia syndrome induced by GI cancers. Support Care Cancer 26(7):2479–2489

    Article  PubMed  Google Scholar 

  21. Vadell C, Segui MA, Gimenez-Arnau JM, Morales S, Cirera L, Bestit I et al (1998) Anticachectic efficacy of megestrol acetate at different doses and versus placebo in patients with neoplastic cachexia. Am J Clin Oncol 21(4):347–351

    Article  CAS  PubMed  Google Scholar 

  22. Ruiz-Garcia V, Lopez-Briz E, Carbonell-Sanchis R, Bort-Marti S, Gonzalvez-Perales JL (2018) Megestrol acetate for cachexia-anorexia syndrome. A systematic review. J Cachexia Sarcopenia Muscle 9(3):444–452

    Article  PubMed  PubMed Central  Google Scholar 

  23. Gullett NP, Hebbar G, Ziegler TR (2010) Update on clinical trials of growth factors and anabolic steroids in cachexia and wasting. Am J Clin Nutr 91(4):1143S-1147S

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Koller E, Gibert C, Green L, Mann M, Bernstein B (1999) Thrombotic events associated with megestrol acetate in patients with AIDS cachexia. Nutrition 15(4):294–298

    Article  CAS  PubMed  Google Scholar 

  25. Ruiz Garcia V, Lopez-Briz E, Carbonell Sanchis R, Gonzalvez Perales JL, Bort-Marti S (2013) Megestrol acetate for treatment of anorexia-cachexia syndrome. Cochrane Database Syst Rev 2013(3):CD004310

  26. Ordu C, Pilanci KN, Koksal UI, Okutur K, Saglam S, Tecimer C et al (2014) Can megestrol acetate induce thrombosis in advanced oncology patients receiving chemotherapy? Asian Pac J Cancer Prev 15(23):10165–10169

    Article  PubMed  Google Scholar 

  27. Simpson EH (1951) The interpretation of interaction in contingency tables. J R Stat Soc Series B Stat Methodol 13(2):238–241

    Google Scholar 

  28. The Korea Ministry of Food and Drug Safety (2018) Megestrol acetate. https://nedrug.mfds.go.kr/pbp/CCBBB01/getItemDetailCache?cacheSeq=201800533aupdateTs2024-02-02%2019:41:59.0b. Accessed 2 Mar 2024

  29. Madeddu C, Dessi M, Panzone F, Serpe R, Antoni G, Cau MC et al (2012) Randomized phase III clinical trial of a combined treatment with carnitine + celecoxib +/- megestrol acetate for patients with cancer-related anorexia/cachexia syndrome. Clin Nutr 31(2):176–182

    Article  CAS  PubMed  Google Scholar 

  30. Wang KL, Yap ES, Goto S, Zhang S, Siu CW, Chiang CE (2018) The diagnosis and treatment of venous thromboembolism in asian patients. Thromb J 16:4

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to thank Jin-Seul Kwak, Jung-Ae Kim, Stella Jung-Hyun Kim, and Hee-Jin Kang of IQVIA Korea for their help to data collection and analysis, Hye-Jung Park, the health information manager of the Gyeongsang National University Hospital for her help to data curation, and the Health Insurance Review and Assessment (HIRA) Services for their cooperation. The research was supported (in part) by the Korean Cancer Study Group (KCSG-PC21-07).

Funding

This work was supported by a grant from Boryung Pharmaceutical Ltd. Seoul, the Republic of Korea.

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Author notes

  1. Chang Min Lee and Jung Hun Kang equally contributed to this work.

Authors and Affiliations

  1. Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea

    Chang Min Lee & Jung Hun Kang

  2. Division of Hematology/Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, 11 Samjeongja-Ro, Changwon, 51472, Republic of Korea

    Se-Il Go

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Contributions

Chang Min Lee was responsible for the formal analysis, investigation, and writing (original draft and review and editing). Jung Hun Kang was responsible for the conceptualization, data curation, investigation, methodology, supervision, and writing (original draft and review and editing). Se-Il Go was responsible for the data curation, formal analysis, investigation, methodology, supervision, validation, and writing (original draft and review and editing).

Corresponding author

Correspondence to Se-Il Go.

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Ethics approval

This study was approved by the Institutional Review Board of Gyeongsang National University Changwon Hospital (GNUCH 2019–11-027) and was conducted in accordance with the principles of the Declaration of Helsinki and its later amendments.

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Informed consent was waived due to the retrospective nature of the study.

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The authors declare no competing interests.

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Lee, C.M., Kang, J.H. & Go, SI. Clinical implication of megestrol acetate in metastatic gastric cancer: a big data analysis from Health Insurance Review and Assessment (HIRA) database. Support Care Cancer 32, 249 (2024). https://doi.org/10.1007/s00520-024-08430-5

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