Randomized comparison of megestrol acetate versus dexamethasone versus fluoxymesterone for the treatment of cancer anorexia/cachexia

Charles Lawrence Loprinzi, John W. Kugler, Jeff A Sloan, James A. Mailliard, James E. Krook, Mary B. Wilwerding, Kendrith M. Rowland, John K Camoriano, Paul J. Novotny, Bradley J. Christensen

Research output: Contribution to journalArticle

250 Citations (Scopus)

Abstract

Purpose: Previous double-blind, placebo-controlled, randomized clinical trials have demonstrated that both corticosteroids and progestational agents do partially alleviate cancer anorexia/cachexia. Pilot information suggested that an anabolic corticosteroid might also improve appetites in patients with cancer anorexia/cachexia. The current trial was developed to compare and contrast a progestational agent, a corticosteroid, and an anabolic corticosteroid for the treatment of cancer anorexia/cachexia. Patients and Methods: Patients suffering from cancer anorexia/cachexia were randomized to receive either dexamethasone 0.75 mg qid, megestrol acetate 800 mg orally every day, or fluoxymesterone 10 mg orally bid. Patients were observed at monthly intervals to evaluate weight changes and drug toxicity. Patients also completed questionnaires at baseline and at monthly intervals to evaluate appetites and drug toxicities. Results: Fluoxymesterone resulted in significantly less appetite enhancement and did not have a favorable toxicity profile. Megestrol acetate and dexamethasone caused a similar degree of appetite enhancement and similar changes in nonfluid weight status, with nonsignificant trends favoring megestrol acetate for both of these parameters. Dexamethasone was observed to have more corticosteroid-type toxicity and a higher rate of drug discontinuation because of toxicity and/or patient refusal than megestrol acetate (36% v 25%; P = .03). Megestrol acetate had a higher rate of deep venous thrombosis than dexamethasone (5% v 1%; P = .06). Conclusion: Whereas fluoxymesterone clearly seems to be an inferior choice for treating cancer anorexia/cachexia, megestrol acetate and dexamethasone have similar appetite stimulating efficacy but differing toxicity profiles.

Original languageEnglish (US)
Pages (from-to)3299-3306
Number of pages8
JournalJournal of Clinical Oncology
Volume17
Issue number10
StatePublished - Oct 1999

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Fluoxymesterone
Megestrol Acetate
Cachexia
Anorexia
Dexamethasone
Appetite
Adrenal Cortex Hormones
Neoplasms
Progestins
Drug-Related Side Effects and Adverse Reactions
Therapeutics
Weights and Measures
Venous Thrombosis
Randomized Controlled Trials
Placebos

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Randomized comparison of megestrol acetate versus dexamethasone versus fluoxymesterone for the treatment of cancer anorexia/cachexia. / Loprinzi, Charles Lawrence; Kugler, John W.; Sloan, Jeff A; Mailliard, James A.; Krook, James E.; Wilwerding, Mary B.; Rowland, Kendrith M.; Camoriano, John K; Novotny, Paul J.; Christensen, Bradley J.

In: Journal of Clinical Oncology, Vol. 17, No. 10, 10.1999, p. 3299-3306.

Research output: Contribution to journalArticle

Loprinzi, CL, Kugler, JW, Sloan, JA, Mailliard, JA, Krook, JE, Wilwerding, MB, Rowland, KM, Camoriano, JK, Novotny, PJ & Christensen, BJ 1999, 'Randomized comparison of megestrol acetate versus dexamethasone versus fluoxymesterone for the treatment of cancer anorexia/cachexia', Journal of Clinical Oncology, vol. 17, no. 10, pp. 3299-3306.
Loprinzi, Charles Lawrence ; Kugler, John W. ; Sloan, Jeff A ; Mailliard, James A. ; Krook, James E. ; Wilwerding, Mary B. ; Rowland, Kendrith M. ; Camoriano, John K ; Novotny, Paul J. ; Christensen, Bradley J. / Randomized comparison of megestrol acetate versus dexamethasone versus fluoxymesterone for the treatment of cancer anorexia/cachexia. In: Journal of Clinical Oncology. 1999 ; Vol. 17, No. 10. pp. 3299-3306.
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abstract = "Purpose: Previous double-blind, placebo-controlled, randomized clinical trials have demonstrated that both corticosteroids and progestational agents do partially alleviate cancer anorexia/cachexia. Pilot information suggested that an anabolic corticosteroid might also improve appetites in patients with cancer anorexia/cachexia. The current trial was developed to compare and contrast a progestational agent, a corticosteroid, and an anabolic corticosteroid for the treatment of cancer anorexia/cachexia. Patients and Methods: Patients suffering from cancer anorexia/cachexia were randomized to receive either dexamethasone 0.75 mg qid, megestrol acetate 800 mg orally every day, or fluoxymesterone 10 mg orally bid. Patients were observed at monthly intervals to evaluate weight changes and drug toxicity. Patients also completed questionnaires at baseline and at monthly intervals to evaluate appetites and drug toxicities. Results: Fluoxymesterone resulted in significantly less appetite enhancement and did not have a favorable toxicity profile. Megestrol acetate and dexamethasone caused a similar degree of appetite enhancement and similar changes in nonfluid weight status, with nonsignificant trends favoring megestrol acetate for both of these parameters. Dexamethasone was observed to have more corticosteroid-type toxicity and a higher rate of drug discontinuation because of toxicity and/or patient refusal than megestrol acetate (36{\%} v 25{\%}; P = .03). Megestrol acetate had a higher rate of deep venous thrombosis than dexamethasone (5{\%} v 1{\%}; P = .06). Conclusion: Whereas fluoxymesterone clearly seems to be an inferior choice for treating cancer anorexia/cachexia, megestrol acetate and dexamethasone have similar appetite stimulating efficacy but differing toxicity profiles.",
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AU - Krook, James E.

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N2 - Purpose: Previous double-blind, placebo-controlled, randomized clinical trials have demonstrated that both corticosteroids and progestational agents do partially alleviate cancer anorexia/cachexia. Pilot information suggested that an anabolic corticosteroid might also improve appetites in patients with cancer anorexia/cachexia. The current trial was developed to compare and contrast a progestational agent, a corticosteroid, and an anabolic corticosteroid for the treatment of cancer anorexia/cachexia. Patients and Methods: Patients suffering from cancer anorexia/cachexia were randomized to receive either dexamethasone 0.75 mg qid, megestrol acetate 800 mg orally every day, or fluoxymesterone 10 mg orally bid. Patients were observed at monthly intervals to evaluate weight changes and drug toxicity. Patients also completed questionnaires at baseline and at monthly intervals to evaluate appetites and drug toxicities. Results: Fluoxymesterone resulted in significantly less appetite enhancement and did not have a favorable toxicity profile. Megestrol acetate and dexamethasone caused a similar degree of appetite enhancement and similar changes in nonfluid weight status, with nonsignificant trends favoring megestrol acetate for both of these parameters. Dexamethasone was observed to have more corticosteroid-type toxicity and a higher rate of drug discontinuation because of toxicity and/or patient refusal than megestrol acetate (36% v 25%; P = .03). Megestrol acetate had a higher rate of deep venous thrombosis than dexamethasone (5% v 1%; P = .06). Conclusion: Whereas fluoxymesterone clearly seems to be an inferior choice for treating cancer anorexia/cachexia, megestrol acetate and dexamethasone have similar appetite stimulating efficacy but differing toxicity profiles.

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