Megestrol acetate for treatment of anorexia-cachexia syndrome

Berenstein, Etelvina Graciela; Ortiz, Zulma

doi:10.1002/14651858.cd004310.pub2

Cited by 144 publications

(89 citation statements)

References 45 publications

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“…They include mainly appetite stimulants and anabolic agents such as prednisolone [15,51] and progesterone [12,42,43,77] and ghrelin, a ligand which stimulates growth hormone release [44,59]. Anecdotally, the use of α-3 omega fatty acids (eicosapentaenoic acid) [52] and thalidomide (potent anti-TNF activity) have been reported [48].…”

Section: Discussionmentioning

confidence: 99%

Selective Inhibition of NF-kappa-B with NBD Peptide Reduces Tumor- Induced Wasting in a Murine Model of Cancer Cachexia In vivo

Wysong¹,

Asher

Yin

et al. 2011

JCST

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Cancer cachexia is a severe wasting syndrome characterized by the progressive loss of lean body mass and systemic inflammation, which is seen in as many as 80% of patients with advanced malignancy. It accounts for an estimated 20-30% of all cancer-related deaths. The mechanism by which cancer induces skeletal muscle atrophy in cachexia involves tumor-derived cytokines, including TNFα, IL-1, and IL-6. Upon interaction with their unique receptors on skeletal muscle, these cytokines activate NF-kappaB, a transcription factor crucial for atrophy related sarcomere proteolysis to occur. The significance of NF-κB is highlighted in studies demonstrating that genetic inhibition of NF-κB ameliorates cancer-induced muscle loss in vivo. In the present study, we evaluate a selective NF-kappaB inhibitor (NBD peptide) which targets the IkappaB complex to prevent cancer-induced skeletal muscle atrophy in an established mouse model (C26 adenocarcinoma). We identified for the first time that NBD peptide can directly inhibit tumor-induced NFkappaB activation in skeletal muscle, resulting in a decrease loss of lean muscle. We also identified that NBD peptide reduces the expression of the tumor induced ubiquitin ligases MuRF-1 and MAFbx/Atrogin-1 necessary for atrophy. These findings highlight that NBD peptide may be a potential selective therapeutic agent for the treatment of cancer cachexia.

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Section: Discussionmentioning

confidence: 99%

Selective Inhibition of NF-kappa-B with NBD Peptide Reduces Tumor- Induced Wasting in a Murine Model of Cancer Cachexia In vivo

Wysong¹,

Asher

Yin

et al. 2011

JCST

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“…Literature review did not show an effect of megestrol acetate on increased survival among patients with malignancy-related cachexia, and the effect of this drug on the quality of life remains debatable [24].…”

Section: Discussionmentioning

confidence: 99%

Assessment of risk factors for mortality in patients with cardiovascular disease and a history of treatment for malignancy

et al. 2015

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A b s t r a c tBackground: Patients with advanced cancer after radio-and/or chemotherapy are increasingly commonly hospitalised in cardiology units due to coexisting cardiovascular diseases (CVD). A rational assessment of mortality risk is an important part of patient preparation for invasive cardiac procedures. One disadvantage of cardiac risk scores is the fact that malignancies are not taken into account. At present, accurate estimation of life expectancy is possible in up to 20% of patients with an advanced malignancy. Aim:To evaluate the effect of selected clinical parameters on survival of patients with CVD and coexisting lung or breast cancer after radio-and/or chemotherapy. An additional aim was to identify patients with a high probability of surviving a year in a good general clinical condition. Methods:The study group involved 326 subjects with established CVD and lung cancer (small-cell or non-small-cell) or breast cancer who were selected from the group of 7818 patients receiving palliative care in the Palium hospice in Czestochowa, Poland, in 2008Poland, in -2012. The obtained data were collected in a database and subjected to a statistical analysis. Results:The strongest factors associated with an increased risk of death among patients with CVD and coexisting advanced lung or breast cancer after chemo-and/or radiotherapy were the type and stage of malignancy, functional status according to the ECOG classification, and the presence of cachexia. Other factors that had a significant effect on survival included higher severity of heart failure symptoms as evaluated by the New York Heart Association class, decreased left ventricular ejection fraction, presence of ischaemic heart disease, chronic obstructive pulmonary disease, fasting hyperglycaemia, and the severity of fatigue, nausea, and pain. When the effects of drug treatment on survival were analysed, significantly increased survival was observed in patients treated with angiotensin-converting enzyme inhibitors while diuretic and glucocorticosteroid use was associated with decreased survival. Among the evaluated groups of patients with CVD and advanced malignancy after radio-and/or chemotherapy, the highest probability of surviving a year in a relatively good general clinical condition was noted in patients with stage 3 breast cancer without cachexia, ischaemic heart disease and persistent somatic symptoms who were treated with tamoxifen, angiotensin-converting enzyme inhibitors and megestrol acetate.Conclusions: This is the first study that evaluated the combined effect of oncological and cardiovascular risk factors on survival of patients with CVD and coexisting cancer after radio-and/or chemotherapy treatment. When the three groups of cancer patients with different prognosis were compared, the study revealed varying effects of each factor depending on the underlying malignancy. The analysis confirmed the significance of the cumulative risk. The present study showed that malignancy-related prognostic factors are important in the context of cardi...

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“…Nutritional counseling, oral nutritional supplementation, and home parenteral nutrition (HPN) have also been linked to improved QoL [13]. Finally, while appetite stimulants, such as megestrol acetate (Megace ® ), are thought to improve cancer-related anorexia-cachexia, they have not been shown to affect survival and/or global QoL [14,15]. Interestingly, Megace is thought to be more effective than either eicosapentaenoic acid (alpha 3-omega fatty acid) or marijuana derivatives; and only corticosteroids are as effective as Megace [15].…”

Section: Cachexia and Malnutritionmentioning

confidence: 99%

“…Finally, while appetite stimulants, such as megestrol acetate (Megace ® ), are thought to improve cancer-related anorexia-cachexia, they have not been shown to affect survival and/or global QoL [14,15]. Interestingly, Megace is thought to be more effective than either eicosapentaenoic acid (alpha 3-omega fatty acid) or marijuana derivatives; and only corticosteroids are as effective as Megace [15]. Unfortunately, Megace carries the risk of venous thromboembolism (VTE), perhaps as high as a sixfold increase, thus limiting its use in the gynecologic oncology patient population [16].…”

Section: Cachexia and Malnutritionmentioning

confidence: 99%