Abstract
Purpose
The purpose of the study was to determine the effectiveness of megestrol acetate (MA) and olanzapine (OLN) for the treatment of cancer-related anorexia (CRA).
Methods
Eighty adult patients with advanced gastrointestinal cancer or lung cancer (stages III and IV) with CRA (loss of appetite and greater than or equal to 5% loss of preillness stable weight) were randomized to receive daily MA or MA plus OLN for a period of 8 weeks. Patients were assessed weekly using the M.D. Anderson Symptom Inventory with specific measurement of weight, appetite, nausea, and quality of life (QOL) measures.
Results
For the 37 patients receiving MA, 15 patients had a greater than or equal to 5% weight gain, 2 patients had an appetite improvement, 3 patients had an improvement in nausea, and 5 patients had an improvement in QOL at both 4 and 8 weeks. For the 39 patients receiving MA plus OLN, 33 patients had a greater than or equal to 5% weight gain, 25 patients had an appetite improvement, 21 patients had an improvement in nausea, and 23 patients had an improvement in QOL at both 4 and 8 weeks, and there was an improvement in general activity, mood, work, walking, and enjoyment at 8 weeks. There were no grade III or IV treatment-related toxicities in patients receiving MA or the combination of MA plus OLN.
Conclusions
The combination of MA and OLN appears to be an effective intervention for patients with CRA.
Similar content being viewed by others
References
Sarhil N, Mahmoud F, Walsh D et al (2003) Evaluation of nutrition status in advanced metastatic cancer. Support Care Cancer 11:652–659
Tramner JE, Heyland D, Dudgeon D et al (2003) Measuring the symptom experience of seriously ill cancer and noncancer hospitalized patients near the end of life with the memorial symptom assessment scale. J Pain Symptom Manage 25:420–429
Jatoi A (2006) Pharmacologic therapy for the cancer anorexia/weight loss syndrome: a data-driven practical approach. J Support Oncol 4:499–502
Yavuzsen T, Davis MP, Walsh D et al (2005) Systemic review of the treatment of cancer-associated anorexia and weight loss. J Clin Oncol 23:8500–8511
Fearon KCH (2008) Cancer cachexia: developing multimodal therapy for a multidimensional problem. European J Cancer 44:1124–1132
Jatoi A, Kumar S, Sloan JA, Nguyen PL (2003) On appetite and its loss. J Clin Oncol 21(9 suppl):79–81
Bymaster FP, Calligaro D, Falcone J et al (1996) Radioreceptor binding profile of the atypical antipsychotic olanzapine. Neuropsychopharmacology 14:87–96
Bymaster FP, Falcone JF, Bauzon D et al (2001) Potent antagonism of 5HT3 and 5HT6 receptors by olanzapine. Eur J Pharmacol 430:341–349
Allison DB, Casey DE (2001) Antipsychotic-associated weight gain: a review of the literature. J Clin Psychiatry 62:22–31
Hale AS (1997) Olanzapine. Br J Hosp Med 58:443–445
Goldstein LE, Sporn J, Brown S et al (1999) New-onset diabetes mellitus and diabetic ketoacidosis associated with olanzapine treatment. Psychosomatics 40:438–443
Parsons B, Allison DB, Loebel A et al (2008) Weight effects associated with antipsychotics: a comprehensive database analysis. Schizophr Res 110:103–110
Navari RM, Einhorn LH, Loehrer PJ et al (2005) A phase II trial of olanzapine for the prevention of chemotherapy-induced nausea and vomiting. Support Care Cancer 13:529–534
Navari RM, Einhorn LH, Loehrer PJ et al (2007) A phase II trial of olanzapine, dexamethasone, and palonosetron for the prevention of chemotherapy-induced nausea and vomiting. Support Care Cancer 15:1285–1291
Passik SD, Lundberg J, Kirsh KL et al (2002) Clinical note: a pilot exploration of the antiemetic activity of olanzapine for the relief of nausea in patients with advanced pain and cancer. J Pain Symptom Manage 23:526–532
Cleland CS, Mendoza TR, Wang XS et al (2000) Assessing symptom distress in cancer patients: the M.D. Anderson Symptom Inventory. Cancer 89:1634–1646
Cella DF, Tulsky DS, Gray G et al (1993) The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 11:570–579
Jackson WC, Tavernier L (2003) Olanzapine for intractable nausea in palliative care patients. J Palliative Care 6:251–255
Srivastava M, Brito-Delan N, Davis MP et al (2003) Olanzapine as an antiemetic in refractory nausea and vomiting in advanced cancer. J Pain Symptom Manage 25:578–582
Thibault R, Goujon N, LeGallic E et al (2009) Use of 10-point analogue scales to estimate dietary intake: a prospective study in patients nutritionally at-risk. Clin Nutr 28:134–140
Woods CA, Cumming B (2009) The impact of test medium on use of visual analogue scales. Eye Contact Lens 35:6–10
Acknowledgments
The study was supported by the Walther Cancer Foundation and the Reich Family Endowment for the care of the whole patient.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Navari, R.M., Brenner, M.C. Treatment of cancer-related anorexia with olanzapine and megestrol acetate: a randomized trial. Support Care Cancer 18, 951–956 (2010). https://doi.org/10.1007/s00520-009-0739-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-009-0739-7