The effect of cyproheptadine hydrochloride (periactin) and megestrol acetate (megace) on weight in children with cancer/treatment-related cachexia.
BACKGROUND
Children with cancer frequently have associated cachexia and malnutrition. Failure to thrive affects nearly 40% of oncology patients with advanced or progressive disease. Malnutrition can erode quality of life and adversely impact disease prognosis. Appetite stimulation and increased food intake is 1 approach to combat cancer-related cachexia.


METHODS
Cyproheptadine hydrochloride (CH), an appetite stimulant, was administered to children with cancer-associated cachexia to prevent further weight loss. All participants started CH and were evaluated for response after 4 weeks. Efficacy of megestrol acetate (MA) was evaluated in patients who did not respond to CH. Medical evaluation, weight measurements, prealbumin, and serum leptin levels were preformed at follow-up visits.


RESULTS
Seventy patients were enrolled. Of the 66 evaluable patients, 50 demonstrated a response to CH (average weight gain 2.6 kg and mean weight-for-age z-score change of 0.35, P=0.001). Seven of the 16 nonresponders received MA. Six patients completed 4 weeks of MA, 5 responded (average weight gain of 2.5 kg). The most commonly reported side effect of CH was drowsiness. One patient on MA developed low cortisol levels and hyperlipidemia.


CONCLUSIONS
This study demonstrates that CH is a safe and effective way to promote weight gain in children with cancer/treatment-related cachexia.
Couluris
Marisa
M
Department of Pediatrics, University of South Florida, Tampa, FL 33612, USA. Marisa.Couluris@epi.usf.edu
Mayer
Jennifer L R
JL
Freyer
David R
DR
Sandler
Eric
E
Xu
Ping
P
Krischer
Jeffrey P
JP
D000293:Adolescent; D000328:Adult; D019167:Appetite Stimulants / Q000627:therapeutic use*; D002100:Cachexia / Q000188:drug therapy* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003533:Cyproheptadine / Q000627:therapeutic use*; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D019290:Megestrol Acetate / Q000627:therapeutic use*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000188:drug therapy; D009369:Neoplasms / Q000150:complications* / Q000473:pathology; D011379:Prognosis; D011788:Quality of Life; D015430:Weight Gain / Q000187:drug effects*
D019167:Appetite Stimulants; D005765:Gastrointestinal Agents; D003533:Cyproheptadine; D019290:Megestrol Acetate