Effects of megestrol acetate in patients with cancer anorexia-cachexia syndrome--a systematic review and meta-analysis.

@article{Leniak2008EffectsOM,
  title={Effects of megestrol acetate in patients with cancer anorexia-cachexia syndrome--a systematic review and meta-analysis.},
  author={Wiktoria Leśniak and Małgorzata M. Bała and Roman Z. Jaeschke and Maciej J Krzakowski},
  journal={Polskie Archiwum Medycyny Wewnetrznej},
  year={2008},
  volume={118 11},
  pages={
          636-44
        }
}
INTRODUCTION Anorexia-cachexia syndrome (ACS) often occurs in patients with advanced cancer. OBJECTIVES To review the effect of megestrol acetate (MA) in patients with ACS. PATIENTS AND 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… 
Megestrol acetate for treatment of anorexia-cachexia syndrome.
TLDR
This review shows that MA improves appetite and is associated with slight weight gain in cancer, AIDS and in patients with other underlying pathology, and lack of benefit in the same patients when MA was compared to other drugs.
Clinical evaluation and optimal management of cancer cachexia.
TLDR
This work proposes a review based on the literature on the pathophysiology of CACS, the diagnostic criteria and treatment, and future strategies, which include combined treatment and new drugs.
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TLDR
The purpose of this article is to review the pre-existing pharmacologic agents used for CACS and to evaluate the evidence from current studies on each pharmacologic agent.
Cancer anorexia - cachexia syndrome.
TLDR
The diagnosis of cancer cachexia is outlined, its impact on patient quality of life and survival is reviewed, and the reader is updated on potential therapies that may suppress it.
A new look at an old drug for the treatment of cancer cachexia: megestrol acetate.
TLDR
It is concluded that megestrol acetate is a good candidate for muscle wasting treatment and future studies addressed at the interaction between the drug and protein turnover in human skeletal muscle should be performed.
Appetite stimulants for patients with cancer: current evidence for clinical practice.
TLDR
Currently, there is no current standard of care for patients with cancer-related anorexia, and international guidelines recommend promoting anabolism through nutritional, physical, and pharmacologic therapies.
Optimal management of cancer anorexia–cachexia syndrome
TLDR
Although bodyweight is the most important endpoint of any cachexia treatment, body composition, physical performance and quality of life should be monitored and one can speculate that a single therapy may not be completely successful in the treatment of cachexia.
Current and future care of patients with the cancer anorexia-cachexia syndrome.
  • E. D. Del Fabbro
  • Medicine
    American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting
  • 2015
TLDR
The key elements of CACS assessment in daily practice, the contribution of nutritional impact symptoms (NIS), the evidence for current pharmacologic options, and promising anticachexia agents in perclinical and clinical trials are reviewed.
Anamorelin hydrochloride in the treatment of cancer anorexia-cachexia syndrome.
TLDR
The findings of ongoing Phase III studies are needed to confirm the significant potential of anamorelin to treat NSCLC cachexia, as well as to identify the dose-limiting toxicities identified to date.
Update on emerging drugs for cancer cachexia
TLDR
There are several existing and emerging drugs with the potential to ameliorate cancer cachexia, but the most efficacious treatment will probably come from combined drug therapies.
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References

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Systematic review of megestrol acetate in the treatment of anorexia-cachexia syndrome.
TLDR
MA is an effective and safe treatment for ACS in cancer and AIDS patients, particularly in terms of improvement in appetite and weight gain, and shows significant benefits over dronabinol in improving appetite.
High-dose progestins for the treatment of cancer anorexia-cachexia syndrome: a systematic review of randomised clinical trials.
TLDR
The effects of high-dose progestins on appetite and body weight were clearly demonstrated and further studies are undoubtedly warranted to investigate other aspects of progestin activity, especially as regards dosage, duration and timing with best therapeutic index.
Usefulness of Megestrol Acetate in Cancer Cachexia and Anorexia: A Placebo‐Controlled Study
TLDR
It is concluded that therapy with MA at a dose of 240 mg/day improved SSA and was associated with moderate weight gain in patients with hormone-insensitive malignancies.
Prospective randomised trial of two dose levels of megestrol acetate in the management of anorexia-cachexia syndrome in patients with metastatic cancer.
TLDR
The clinical safety and effectiveness of oral MA in the management of ACS in patients with advanced cancer resistant to systemic chemotherapy are confirmed and data concerning the dose escalation of MA dosage in unresponsive patients suggest that a step by step increase in MA dosage could be the best way of administering MA for the Management of ACS.
1253 Efficacy of megestrol acetate on anorexia in patients with advanced non hormone-related tumors: A double-blind placebo controlled clinical trial
TLDR
MA showed a remarkable effect on appetite with a low dose (2 tablets × 160 mg/die) already after 14 days, without side-effects of relief, of great importance considering the relevance of the quality of life and the low life expectancy of these patients and theLow daily therapy costs of this treatment.
Megestrol Acetate for Cachexia and Anorexia in Advanced Non-small Cell Lung Cancer: A Randomized Study Comparing Two Different Doses
TLDR
Although lower doses of megestrol acetate can be effective for anorexia and cachexia, the higher dose level seems to be more efficient.
Effectiveness of megestrol acetate in patients with advanced cancer: a randomized, double-blind, crossover study.
TLDR
Treatment with megestrol acetate results in rapid and significant improvement of symptoms in terminally ill patients at lower doses than previously reported, and the effects are not secondary to nutritional changes.
Controlled trial of megestrol acetate for the treatment of cancer anorexia and cachexia.
TLDR
This study convincingly demonstrated that megestrol acetate can stimulate appetite and food intake in patients with anorexia and cachexia associated with cancer, leading to significant weight gain in a proportion of such patients.
Dronabinol versus megestrol acetate versus combination therapy for cancer-associated anorexia: a North Central Cancer Treatment Group study.
TLDR
In the doses and schedules studied, megestrol acetate provided superior anorexia palliation among advanced cancer patients compared with dronabinol alone, and an improvement in quality of life (QOL) among megestro acetate-treated and combination-treated patients.
Anticachectic efficacy of megestrol acetate at different doses and versus placebo in patients with neoplastic cachexia.
TLDR
This trial supports the efficacy of megestrol acetate at 480 mg/day in the treatment of cancer-related cachexia and anorexia, with mild toxicity, however, performance status and quality of life were not influenced by this treatment.
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