title: A randomized phase III clinical trial of a combined treatment for cachexia in patients with gynecological cancers: evaluating the impact on metabolic and inflammatory profiles and quality of life.
abstract: OBJECTIVE
  Gynecological neoplastic disease progression is characterized by specific energy metabolism alterations and by symptoms including fatigue, anorexia, nausea, anemia, and immunodepression, which result in a cachexia syndrome and a marked decrease in patient quality of life (QoL). Therapeutic protocols associated with appropriate and effective psychological and social support systems are essential to counteract the symptoms of neoplastic disease in incurable patients.
  
  
  METHODS
  A phase III randomized study was performed to establish the most effective and safest treatment to improve the key symptoms in advanced gynecological cancer patients, i.e., lean body mass (LBM), resting energy expenditure (REE), fatigue, and QoL. In addition, the impact of the treatment arms on the main metabolic and inflammatory parameters, including C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor (TNF)-α, leptin, reactive oxygen species (ROS), and glutathione peroxidase, was evaluated. The change in the Glasgow Prognostic Score (GPS) during treatment was also assessed. A total of 104 advanced-stage gynecological cancer patients were enrolled and randomly assigned to receive either megestrol acetate (MA) plus l-carnitine, celecoxib, and antioxidants (arm 1) or MA alone (arm 2). The treatment duration was 4 months.
  
  
  RESULTS
  The combination arm was more effective than arm 2 with respect to LBM, REE, fatigue, and global QoL. As for the secondary efficacy endpoints, patient appetite increased, and ECOG PS decreased significantly in both arms. The inflammation and oxidative stress parameters IL-6, TNF-α, CRP, and ROS decreased significantly in arm 1, while no significant change was observed in arm 2.
  
  
  CONCLUSIONS
  The combined treatment improved both immunometabolic alterations and patient QoL. Multimodality therapies for cachexia ideally should be introduced within a context of "best supportive care" that includes optimal symptom management and careful psychosocial counseling.
authors.affiliation: Department of Obstetrics and Gynecology, Sirai Hospital, Carbonia, Italy. a.maccio@tin.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Macciò
authors.forename: Clelia
authors.initials: C
authors.lastname: Madeddu
authors.forename: Giulia
authors.initials: G
authors.lastname: Gramignano
authors.forename: Carlo
authors.initials: C
authors.lastname: Mulas
authors.forename: Carlo
authors.initials: C
authors.lastname: Floris
authors.forename: Eleonora
authors.initials: E
authors.lastname: Sanna
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Cau
authors.forename: Filomena
authors.initials: F
authors.lastname: Panzone
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mantovani
mesh_terms: D000328:Adult; D000368:Aged; D000975:Antioxidants / Q000009:adverse effects / Q000627:therapeutic use*; D002100:Cachexia / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D002331:Carnitine / Q000009:adverse effects / Q000627:therapeutic use*; D000068579:Celecoxib; D005260:Female; D005833:Genital Neoplasms, Female / Q000188:drug therapy* / Q000378:metabolism* / Q000473:pathology; D006801:Humans; D007249:Inflammation / Q000378:metabolism / Q000473:pathology; D019290:Megestrol Acetate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies; D011720:Pyrazoles / Q000009:adverse effects / Q000627:therapeutic use*; D011788:Quality of Life; D013449:Sulfonamides / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000975:Antioxidants; D011720:Pyrazoles; D013449:Sulfonamides; D000068579:Celecoxib; D002331:Carnitine; D019290:Megestrol Acetate