title: Randomized comparison of megestrol acetate versus dexamethasone versus fluoxymesterone for the treatment of cancer anorexia/cachexia.
abstract: OBJECTIVE
  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 appetite 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.
  
  
  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 appetite 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA. loprinzi.charles@mayo.edu
authors.forename: C L
authors.initials: CL
authors.lastname: Loprinzi
authors.forename: J W
authors.initials: JW
authors.lastname: Kugler
authors.forename: J A
authors.initials: JA
authors.lastname: Sloan
authors.forename: J A
authors.initials: JA
authors.lastname: Mailliard
authors.forename: J E
authors.initials: JE
authors.lastname: Krook
authors.forename: M B
authors.initials: MB
authors.lastname: Wilwerding
authors.forename: K M
authors.initials: KM
authors.lastname: Rowland
authors.forename: J K
authors.initials: JK
authors.lastname: Camoriano
authors.forename: P J
authors.initials: PJ
authors.lastname: Novotny
authors.forename: B J
authors.initials: BJ
authors.lastname: Christensen
mesh_terms: D000284:Administration, Oral; D000368:Aged; D045930:Anabolic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D000855:Anorexia / Q000188:drug therapy* / Q000209:etiology; D000932:Antiemetics / Q000627:therapeutic use*; D001066:Appetite / Q000187:drug effects*; D001835:Body Weight; D002100:Cachexia / Q000188:drug therapy* / Q000209:etiology; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D005474:Fluoxymesterone / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D019290:Megestrol Acetate / Q000627:therapeutic use*; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000503:physiopathology*; D016896:Treatment Outcome; D015430:Weight Gain
chemical_list: D045930:Anabolic Agents; D000932:Antiemetics; D003907:Dexamethasone; D005474:Fluoxymesterone; D019290:Megestrol Acetate