Assessment of gastrointestinal function and response to megesterol acetate in subjects with gastrointestinal cancers and weight loss.
BACKGROUND
Cancer-associated anorexia/cachexia syndrome (CACS) is common in advanced gastrointestinal malignancies and felt to be due primarily to cytokine-induced appetite suppression. Therapy with an appetite stimulant (megesterol acetate) is commonly employed, but results are sometimes disappointing. We hypothesize that CACS not only suppresses appetite but also interferes with gastrointestinal function.


METHODS
We conducted a prospective study in which 21 subjects with advanced gastrointestinal cancer and weight loss had digestive function. Patients were assessed using an indirect stable isotope method, and nutritional parameters were determined following which patients were treated with megesterol acetate for 4 weeks. Nutritional parameters were then reassessed, weight change determined, and the results were correlated with digestive function results obtained at the initiation of the study.


RESULTS
Abnormal gastrointestinal function based on the stable isotope test was common (86% of patients). The majority of the abnormal function appeared to be due to abnormal pancreatic function testing, in which 17/21 subjects recorded low results. Initial albumin, prealbumin, and carotene values were also frequently abnormal (55-65% of patients). Megesterol acetate therapy resulted in a weight gain in most (75%) patients, although serum albumin fell modestly in the group (average decrease of 0.2 mg/dl). However, prealbumin levels rose in 70% and carotene levels rose in 55%. The degree of weight gain was negatively correlated with previous self-reported weight loss ( r=-0.53, p<0.05), and positively correlated ( p<0.05) with pretherapy carotene ( r=0.58), prealbumin ( r=0.61) and the pancreatic function (digestive) phase of the digestive function test ( r=0.41).


CONCLUSIONS
These data suggest that abnormal digestive function is commonly seen in subjects with CACS and advanced gastrointestinal cancer, and that both pretherapy digestive function and nutritional status can predict or possibly influence the outcome of hormonal appetite stimulation therapy.
Deutsch
John
J
Cancer Center, University of Colorado Health Sciences Center, Denver, CO 80262, USA. jdeutsch@smdc.org
Kolhouse
J Fred
JF
D000328:Adult; D000368:Aged; D019167:Appetite Stimulants / Q000494:pharmacology / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D008297:Male; D019290:Megestrol Acetate / Q000494:pharmacology / Q000627:therapeutic use*; D008875:Middle Aged; D009752:Nutritional Status; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D019282:Wasting Syndrome / Q000188:drug therapy* / Q000209:etiology; D015430:Weight Gain / Q000187:drug effects; D015431:Weight Loss / Q000187:drug effects*
D019167:Appetite Stimulants; D019290:Megestrol Acetate