Effects of megestrol acetate in patients with cancer anorexia-cachexia syndrome--a systematic review and meta-analysis.
BACKGROUND
Anorexia-cachexia syndrome (ACS) often occurs in patients with advanced cancer.


OBJECTIVE
To review the effect of megestrol acetate (MA) in patients with ACS.


METHODS
To identify eligible studies, systematic review by Lopez et al. (2004) was used, electronic databases (MEDLINE, EMBASE and CENTRAL) were searched and reference lists of included studies were reviewed. The studies were included in the review if they were randomized, enrolled patients with non-hormone-sensitive cancer and ACS and assessed the effects of MA compared with placebo, other drugs or different doses of MA.


RESULTS
The study population is characterized by high mortality and progressive weight loss irrespective of the treatment. Compared to placebo, the effect of MA on survival is similar, but MA increases appetite (number needed to treat [NNT]: 3) and leads to weight gain (NNT: 8) in more patients. The data on other aspects of the quality of life are limited. The comparison of MA and glucocorticosteroids showed no statistical difference in their effect on appetite and weight.


CONCLUSIONS
Compared to placebo, MA reduces the symptoms of ACS, with no effect on survival. The beneficial effect of MA on the overall quality of life has not been confirmed. In identified studies the effect of MA and glucocorticosteroids on anorexia and cachexia is similar. The estimation of the treatment utility in ACS depends on the weight attributed to discomfort caused by symptoms, adverse effects of the drugs and the treatment cost. Because of the low quality of the included studies a new randomized controlled trial is needed for valid assessment of the effects of MA.
Leśniak
Wiktoria
W
Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland. lesniak@mp.pl
Bała
Małgorzata
M
Jaeschke
Roman
R
Krzakowski
Maciej
M
D000855:Anorexia / Q000188:drug therapy* / Q000209:etiology; D001066:Appetite / Q000187:drug effects; D019167:Appetite Stimulants / Q000008:administration & dosage*; D001835:Body Weight / Q000187:drug effects; D002100:Cachexia / Q000188:drug therapy* / Q000209:etiology; D004305:Dose-Response Relationship, Drug; D006801:Humans; D019290:Megestrol Acetate / Q000008:administration & dosage*; D009369:Neoplasms / Q000150:complications; D016032:Randomized Controlled Trials as Topic; D013577:Syndrome; D016896:Treatment Outcome
D019167:Appetite Stimulants; D019290:Megestrol Acetate