High-Dose Progestins for the Treatment of Cancer Anorexia-Cachexia Syndrome

A systematic review 1 including 15 RCTs with a total of 2 102 subjects was abstracted in DARE. Dichotomous data for weight gain were available from 11 trials. The pooled OR for weight gain was 2.66 (95% CI: 1.80 to 3.92), favouring high-dose progestins i.e. megestrol acetate (MA) and medroxyprogesterone acetate (MPA), over placebo. The analysis of the 5 trials that excluded the administration of any form of antiblastic treatment, even with purely palliative intent, showed a very similar OR estimate of 2.73 (95% CI: 1.27 to 5.85).

Dichotomous data for appetite were available from 6 trials. The pooled OR from these trials was 4.23 (95% CI: 2.53 to 7.04), favouring high-dose progestins. The analysis of the 4 studies that enrolled patients who had not undergone concurrent treatments, gave a pooled OR of 5.90 (95% CI: 3.39 to 10.27).

The following decision support rules contain links to this evidence summary:

• Megestrol in the treatment of terminal cachexia http://www.ebmeds.org/ebmeds/ebmeds_home.asp?mode=scripts&submode=view&id=scr00537&country=UK

References

• Maltoni M, Nanni O, Scarpi E, Rossi D, Serra P, Amadori D. High-dose progestins for the treatment of cancer anorexia-cachexia syndrome: a systematic review of randomised clinical trials. Ann Oncol 2001 Mar;12(3):289-300. [PubMed] [DARE]