Progestagens and Corticosteroids in the Management Cancer Cachexia

  • Davide Tassinari
  • Marco Maltoni


Over the past few years, many authors have approached the problem of the treatment of cancer cachexia focusing on either the knowledge of the main pathogenetic events, or the outcomes of the treatment in terms of symptoms or improvement in quality of life [1] [8]. The relevance of clinical investigations of cancer anorexia-cachexia has epidemiological and clinical roots, considering that it is very frequent in advanced and terminal disease (up to 40% of patients with advanced disease, and more than 80% of terminal patients), and that its clinical manifestations often represent a source of great concern for both patients and relatives [1] [5]. The clinical approach to cancer anorexia-cachexia has been directed towards different targets, and it can be aetiological, pathogenetic or symptomatic according to the attention paid to tumour growth, the main pathogenetic events, or the clinical behaviour of the syndrome. However, it is mandatory to define both the biological and clinical rationale of the different therapeutic options, and the outcomes of every therapeutic approach, using an evidence-based model.


Palliative Care Clin Oncol Cancer Cachexia Medroxyprogesterone Acetate Cytokine Cascade 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Laviano A, Meguid MM, Rossi-Fanelli F (2003) Cancer anorexia: clinical implications, pathogenesis and therapeutic strategies. Lancet Oncol 4:686–694PubMedCrossRefGoogle Scholar
  2. 2.
    Inui A (2002) Cancer anorexia-cachexia syndrome: current issues in research and management. CA Cancer J Clin 52:72–91PubMedCrossRefGoogle Scholar
  3. 3.
    Nelson KA (2000) The cancer anorexia-cachexia syndrome. Semin Oncol 27:64–68PubMedGoogle Scholar
  4. 4.
    Davis MP, Dickerson D (2000) Cachexia and anorexia: cancer’s covert killer. Support Care Cancer 8:180–187PubMedCrossRefGoogle Scholar
  5. 5.
    Puccio M, Nathanson L (1997) The cancer cachexia syndrome. Semin Oncol 24:277–287PubMedGoogle Scholar
  6. 6.
    Kotler DP (2000) Cachexia. Ann Intern Med 133:622–634PubMedGoogle Scholar
  7. 7.
    Dunlop RJ, Camplell CW (2000) Cytokines and advanced cancer. J Pain Symptom Manage 20:214–232PubMedCrossRefGoogle Scholar
  8. 8.
    Mantovani G, Macciò A, Massa E, Madeddu C (2001) Managing cancer-related anorexia/cachexia. Drug 61:499–514CrossRefGoogle Scholar
  9. 9.
    Jatoi A, Loprinzi CL (2002) Anorexia/weight loss. In: Berger AM, Portenoy RK, Weissman DE (eds) Principles and practice of palliative care and supportive oncology, 2nd edn. Lippincott Williams and Wilkins, Philadelphia, pp 169–177Google Scholar
  10. 10.
    Strasser F (2004) Pathophysiology of the anorexia/cachexia syndrome. In: Doyle D, Hanks G, Cherny N, Caiman K (eds) Oxford textbook of palliative medicine, 3rd edn. Oxford University Press, New York, pp 520–533Google Scholar
  11. 11.
    Rink TJ (1994) In search of a satietary factor. Nature 372:406–407PubMedCrossRefGoogle Scholar
  12. 12.
    Spina M, Merlo-Pick E, Chan RKW et al (1996) Appetite suppressing effect of urocortin, a CRFrelated neuropeptide. Science 273:1561–1564PubMedCrossRefGoogle Scholar
  13. 13.
    Beck SA, Mulligan HD, Tisdale MJ (1990) Lipolytic factors associated with murine and human cancer cachexia. J Natl Cancer Inst 82:1922–1926PubMedCrossRefGoogle Scholar
  14. 14.
    Todorov P, Cariuk P, McDevitt T et al (1996) Characterisation of a cancer cachectic factor. Nature 379:739–742PubMedCrossRefGoogle Scholar
  15. 15.
    Khan S, Tisdale MJ (1999) Catabolism of adipose tissue by a tumor produced lipid mobilising factor. Int J Cancer 80:444–447PubMedCrossRefGoogle Scholar
  16. 16.
    Hussey HJ, Tisdale MJ (1999) Effect of a cachectic factor on carbohydrate metabolism and attenuation by eicosapentaenoic acid. Br J Cancer 80:1231–1235PubMedCrossRefGoogle Scholar
  17. 17.
    Belisario JE, Katz M, Chenker E et al (1991) Bioactivity of skeletal muscle proteolysis inducing factor in the plasma proteins from cancer patients with weight loss. Br J Cancer 63:705–710Google Scholar
  18. 18.
    Todorov PT, Deacon M, Tisdale MJ (1997) Structural analysis of a tumor produced sulfated glycoprotein capable of initiating muscle protein degradation. J Biol Chem 272:12279–12288PubMedCrossRefGoogle Scholar
  19. 19.
    Cariuk P, Lorite MJ, Todorov PT et al (1997) Induction of cachexia in mice by a product isolated from the urine of cachectic cancer patients. Br J Cancer 6:606–613Google Scholar
  20. 20.
    Lorite MJ, Thomson MG, Drake JL et al (1998) Mechanism of muscle protein degradation induced by a cancer cachectic factor. Br J Cancer 78:850–856PubMedGoogle Scholar
  21. 21.
    Lorite MJ, Cariuk P, Tisdale MJ (1997) Induction of muscle protein degradation by a tumor factor. Br J Cancer 76:1035–1040PubMedGoogle Scholar
  22. 22.
    Wigmore SJ, Todorov PT, Barber MD et al (2000) Characteristics of patients with pancreatic cancer expressing a novel cancer cachectic factor. Br J Surg 87:53–58PubMedCrossRefGoogle Scholar
  23. 23.
    Groundwater P, Beck SA, Barton C et al (1990) Alteration of serum and urinary lipolytic activity with weight loss in cachectic cancer patients. Br J Cancer 62:816–821PubMedGoogle Scholar
  24. 24.
    Cahlin C, Korner A, Axelsson H et al (2000) Experimental cancer cachexia: the role of hostderived cytokines interleukin-6, interleukin-12, interferon-gamma and tumor necrosis factor alpha evaluated in gene knockout bearing mice on C57B1 background and eicosapentaenoic-dependent cachexia. Cancer Res 60:5488–5493PubMedGoogle Scholar
  25. 25.
    Smith HJ, Lorite MJ, Tisdale MJ (1997) Effect of a cancer cachectic factor on protein synthesis/degradation in murine C2C12 myoblast: modulation by eicosapentaenoic acid. Cancer Res 59:5507–5513Google Scholar
  26. 26.
    Beck SA, Smith KL, Tisdale MJ (1991) Anticachectic and antitumor effect of eicosapentaenoic acid and its effect on protein turnover. Cancer Res 51:6089–6093PubMedGoogle Scholar
  27. 27.
    Nakashima J, Tachibana M, Ueno M et al (1998) Association between tumor necrosis factor in serum and cachexia in patients with prostatic cancer. Clin Cancer Res 4:1743–1748PubMedGoogle Scholar
  28. 28.
    Soda K, Kawakami M, Kashii A et al (1995) Manifestations of cancer cachexia induced by colon adenocarcinoma are not fully ascribable to interleukin 6. Int J Cancer 28:332–336CrossRefGoogle Scholar
  29. 29.
    Tisdale MJ (1998) New cachectic factor. Curr Opin Clin Nutr Metab Care 1:253–256PubMedCrossRefGoogle Scholar
  30. 30.
    Albrect JT, Canada TW (1996) Cachexia and anorexia in malignancy. Hematol Oncol Clin North Am 10:791–800CrossRefGoogle Scholar
  31. 31.
    Naguchi Y, Yoshikawa T, Matsumoto A et al (1996) Are cytokines possible mediators of cancer cachexia? Surg Today 26:467–475CrossRefGoogle Scholar
  32. 32.
    Nomura K, Noguchi Y, Yoshikawa T et al (1997) Plasma interleukin-6 is not a mediator of changes in lipoprotein lipase activity in cancer patients. Hepatogastroenterology 44:1519–1526PubMedGoogle Scholar
  33. 33.
    Argiles GM, Lopez-Soriano FJ (1999) The role of cytokines in cancer cachexia. Med Res Rev 19:223–248PubMedCrossRefGoogle Scholar
  34. 34.
    Shibata M, Takekawa M (1999) Increased serum concentrations of circulating soluble receptor for interleukin-2 and its effect as a prognostic indicator in cachectic patients with gastric and colorectal cancer. Oncology 56:54–58PubMedCrossRefGoogle Scholar
  35. 35.
    Bossola M, Muscaritoli M, Bellantone R et al (2000) Serum tumor necrosis factor-alpha levels in cancer patients are discontinuous and correlate with weight loss. Eur J Clin Invest 30:1107–1112PubMedCrossRefGoogle Scholar
  36. 36.
    Maltoni M, Fabbri L, Nanni O et al (1997) Serum levels of tumor necrosis factor alpha and other cytokines do not correlate with weight loss and anorexia in cancer patients. Support Care Cancer 5:130–135PubMedCrossRefGoogle Scholar
  37. 37.
    Mantovani G (2000) Cachexia and anorexia. Support Care Cancer 8:506–507PubMedCrossRefGoogle Scholar
  38. 38.
    Espat NJ, Copeland EM, Moldawer LL et al (1994) Tumor necrosis factor and cachexia: a current perspective. Surg Oncol 3:255–262PubMedCrossRefGoogle Scholar
  39. 39.
    McNamara MJ, Alexander HR, Norton JA (1992) Cytokines and their role in the pathophysiology of cancer cachexia. JPEN J Parenter Enterai Nutr 16(Suppl 6):50–53Google Scholar
  40. 40.
    Moldawer LL, Rogy MA, Lowry SF et al (1992) The role of cytokines in cancer cachexia. JPEN J Parenter Enterai Nutr 16:43–49CrossRefGoogle Scholar
  41. 41.
    Plata-Salaman CR (1992) Central nervous system mechanism contributing to the cachexia-anorexia syndrome. Nutrition 16:43–49Google Scholar
  42. 42.
    Mantovani G, Macciò A, Lai P et al (1998) Cytokines involvement in cancer anorexia/cachexia: role of megestrol acetate and medroxy-progesterone acetate on cytokine down-regulation and improvement of clinical symptoms. Crit Rev Oncog 9:99–106PubMedGoogle Scholar
  43. 43.
    Mantovani G, Macciò A, Esu S et al (1997) Medroxyprogesterone acetate reduces the in vitro production of cytokines and serotonin involved in anorexia/cachexia and emesis by peripheral blood mononuclear cells of cancer patients. Eur J Cancer 33:602–607PubMedCrossRefGoogle Scholar
  44. 44.
    Mantovani G, Macciò A, Lai P et al (1998) Cytokine activity in cancer related anorexia/cachexia: role of megestrol acetate and medroxyprogesterone acetate. Semin Oncol 25(Suppl 6):45–52PubMedGoogle Scholar
  45. 45.
    Peuckmann V, Fisch M, Bruera E (2000) Potential novel uses of thalidomide: focus on palliative care. Drugs 60:273–292PubMedCrossRefGoogle Scholar
  46. 46.
    Schimdt H, Rush B, Simonian G (1996) Thalidomide inhibits TNF response and increases survival following endotoxins in rats. J Surg Res 63:143–146CrossRefGoogle Scholar
  47. 47.
    Bruera E, Neumann C, Pitukskin E et al (1999) Thalidomide in patients with cachexia due to terminal cancer: preliminary report. Ann Oncol 10:857–859PubMedCrossRefGoogle Scholar
  48. 48.
    Lissoni P, Paolorossi F, Tancini G et al (1996) Is there a role for melatonin in the treatment of neoplastic cachexia? Eur J Cancer 32A:1340–1343PubMedCrossRefGoogle Scholar
  49. 49.
    Neri B, DeLeonardis V, Gemelli MT et al (1998) Melatonin as biological response modifier in cancer patients. Anticancer Res 18:1329–1332PubMedGoogle Scholar
  50. 50.
    Tisdale M (1996) Inhibition of lypolysis and muscle protein degradation by EPA in cancer cachexia. Nutrition 12(Suppl 1):531–533Google Scholar
  51. 51.
    DeDeckerre E (1999) Possible beneficial effect of fish and fish N-3 polyunsaturated fatty acids in breast and colorectal cancer. Eur J Cancer Prev 80:1231–1235Google Scholar
  52. 52.
    Barber M, Ross J, Vossa C et al (1999) The effect of an oral nutritional supplement enriched with fish oil on weight-loss in patients with pancreatic cancer. Br J Cancer 81:80–86PubMedCrossRefGoogle Scholar
  53. 53.
    Moertel CG, Schutt AJ, Reitemeir RJ et al (1974) Corticosteroid therapy of preterminal gastrointestinal cancer. Cancer 33:1607–1609PubMedCrossRefGoogle Scholar
  54. 54.
    Ettingen AB, Portenoy RK (1988) The use of corticosteroids in the treatment of symptoms associated with cancer. J Pain Symptom Manage 3:99–103CrossRefGoogle Scholar
  55. 55.
    Lissoni P, Brivio F, Ardizzoia A et al (1993) Subcutaneous therapy with low-dose interleukin-2 plus the neurohormone melatonin in metastatic gastric cancer patients with low performance status. Tumori 79:401–404PubMedGoogle Scholar
  56. 56.
    McMillian DC, O’Gorman P, Fearon KCF et al (1997) A pilot study of megestrol acetate and ibuprofen in the treatment of cachexia in gastrointestinal cancer patients. Br J Cancer 76:788–790Google Scholar
  57. 57.
    Cerchietti LCA, Navigante AH, Peluffo GD et al (2004) Effects of celecoxib, medroxyprogesterone and dietary intervention on systemic syndromes in patients with advanced lung adenocarcinoma: a pilot study. J Pain Symptom Manage 27:85–95PubMedCrossRefGoogle Scholar
  58. 58.
    Arteaga CL, Moulder SL, Yakes M (2002) HER (erbB) tyrosine kinase inhibitors in the treatment of breast cancer. Semin Oncol 29(Suppl 11):4–10PubMedCrossRefGoogle Scholar
  59. 59.
    Pegram MD, Reese DM (2002) Combined biological therapy of breast cancer using monoclonal antibodies directed against HER2/neu protein and vascular endothelial growth factor. Semin Oncol 29(Suppl 11):29–37PubMedCrossRefGoogle Scholar
  60. 60.
    Ligibel JA, Winer EP (2002) Trastuzumab/chemotherapy combination in metastatic breast cancer. Semin Oncol 29(Suppl 11):38–43PubMedCrossRefGoogle Scholar
  61. 61.
    Ritter CA, Arteaga CL (2003) The epidermal growth factor receptor-tyrosine kinase: a promising therapeutic target in solid tumors. Semin Oncol 30(Suppl 1):3–11PubMedCrossRefGoogle Scholar
  62. 62.
    Cella D (2003) Impact of ZD1839 on non small cell lung cancer related symptoms as measured by the functional assessment of cancer therapy lung scale. Semin Oncol 30(Suppl 1):39–48PubMedCrossRefGoogle Scholar
  63. 63.
    Douglass EC (2003) Development of ZD1839 in colorectal cancer. Semin Oncol 30(Suppl 6):17–22PubMedCrossRefGoogle Scholar
  64. 64.
    Grunwald V, Hidalgo M (2003) Development of the epidermal growth factor receptor inhibitor OSI-774. Semin Oncol 30(Suppl 6):23–31PubMedCrossRefGoogle Scholar
  65. 65.
    Swaton C (2004) Cell-cycle targeted therapies. Lancet Oncol 5:27–36CrossRefGoogle Scholar
  66. 66.
    Johnson P, Glennie M (2003) The mechanism of action of rituximab in the elimination of tumor cells. Semin Oncol 30(Suppl 2):3–8PubMedCrossRefGoogle Scholar
  67. 67.
    Tassinari D, Sartori S, Maltoni M et al (2004) Target therapies in palliative care: from a clinical to a biological approach. J Pain Symptom Manage 28:195–197PubMedCrossRefGoogle Scholar
  68. 68.
    Rubin H (2003) Cancer cachexia: its correlations and causes. Proc Natl Acad Sci USA 100:5384–5389PubMedCrossRefGoogle Scholar
  69. 69.
    Anonymous (1996) Outcomes of cancer treatment for technology assessment and cancer treatment guidelines. Amercian Society of Clinical Oncology. J Clin Oncol 14:671–679Google Scholar
  70. 70.
    Kaasa S, Loge JH (2003) Quality of life in palliative care: principles and practice. Palliat Med 17:11–20PubMedCrossRefGoogle Scholar
  71. 71.
    Kaasa S, Loge JH (2002) Quality of life assessment in palliative care. Lancet Oncol 3:175–182PubMedCrossRefGoogle Scholar
  72. 72.
    Cochrane AL (1972) Effectiveness and efficiency: random reflection on health services. Royal Society of Medicine, LondonGoogle Scholar
  73. 73.
    Haynes B (1999) Can it work? Does it work? Is it worth it? BMJ 319:652–653PubMedGoogle Scholar
  74. 74.
    Tassinari D (2003) Surrogate end point of quality of life assessment: have we really found what we are looking for? Health Qual Life Outcomes 1:71PubMedCrossRefGoogle Scholar
  75. 75.
    Tassinari D, Poggi B, Fantini M et al (2003) Can we really consider quality of life as an outcome of palliative care? J Pain Symptom Manage 26:886–887PubMedCrossRefGoogle Scholar
  76. 76.
    Tassinari D, Panzini I, Sartori S, Ravaioli A (2003) Surrogate outcomes in quality of life research: where we will end up? J Clin Oncol 21:1894–1895PubMedCrossRefGoogle Scholar
  77. 77.
    Tassinari D, Panzini I, Ravaioli A et al (2002) Quality of life at the end of life: how is the solution far away? J Clin Oncol 20:1704–1705PubMedGoogle Scholar
  78. 78.
    Hwang SS, Chang VT, Fairclough DL et al (2003) Longitudinal quality of life in advanced cancer patients: pilot study results from a VA medical center. J Pain Symptom Manage 25:225–235PubMedCrossRefGoogle Scholar
  79. 79.
    Goodwin DM, Higginson IJ, Myers K et al (2003) Effectiveness of palliative day care in improving pain, symptom control and quality of life. J Pain Symptom Manage 25:202–212PubMedCrossRefGoogle Scholar
  80. 80.
    Cook DJ, Guyatt GH, Laupacis A, Sackett DL (1992) Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 102(Suppl 4):305S–311SPubMedGoogle Scholar
  81. 81.
    Harbour R, Miller J (2001) A new system for grading recommendations in evidence based guidelines. BMJ 323:334–336PubMedCrossRefGoogle Scholar
  82. 82.
    Tassinari D, Maltoni M, Amadori D (2002) Prediction of survival in terminally ill cancer patients: why we cannot avoid an evidence-based palliative medicine. Ann Oncol 13:1322–1323Google Scholar
  83. 83.
    Kaasa S, De Conno F (2001) Palliative care research. Eur J Cancer 37(Suppl 8):153S–159SCrossRefGoogle Scholar
  84. 84.
    Henriksen H, Gamborg H, Leikersfeldt G (2003) Corticosteroids in palliation of preterminal and terminal cancer patients. Evidence or empiricism? Ugeskr Laeger 165:3913–3917PubMedGoogle Scholar
  85. 85.
    Moertel C, Schutt AG, Reiteneier RJ et al (1974) Corticosteroid therapy of pre-terminal gastrointestinal cancer. Cancer 33:1607–1609PubMedCrossRefGoogle Scholar
  86. 86.
    Willox J, Corr J, Shaw J et al (1984) Prednisolone as an appetite stimulant in patients with cancer. BMJ 288:27PubMedCrossRefGoogle Scholar
  87. 87.
    Bruera E, Roca E, Cedaro L et al (1985) Action of oral methylprednisolone in terminal cancer patients: a prospective randomized double blind study. Cancer Treat Rep 69:751–754PubMedGoogle Scholar
  88. 88.
    Robustelli della Cuna G, Pellegrini A, Piazzi M (1989) Effect of methylprednisolone sodium succinate on quality of life in pre-terminal cancer patients: a placebo controlled multicenter study. Eur J Cancer Clin Oncol 25:1823–1829CrossRefGoogle Scholar
  89. 89.
    Popiela T, Lucchi R, Giongo F (1989) Methylprednisolone as palliative therapy for female terminal cancer patients. Eur J Cancer Clin Oncol 25:1823–1829PubMedCrossRefGoogle Scholar
  90. 90.
    Barnes EA, Bruera E (2002) Fatigue in patients with advanced cancer: a review. Int J Gynecol Cancer 12(5):424–428PubMedCrossRefGoogle Scholar
  91. 91.
    Bruera E, Neumann CM (1998) Management of specific symptom complexes in patients receiving palliative care. CMAJ 158:1717–1726PubMedGoogle Scholar
  92. 92.
    Bruera ED, MacEachern TJ, Spachynski KA et al (1994) Comparison of the efficacy, safety, and pharmacokinetics of controlled release and immediate release metoclopramide for the management of chronic nausea in patients with advanced cancer. Cancer 74:3204–3211PubMedCrossRefGoogle Scholar
  93. 93.
    Watanabe S, Bruera E (1994) Corticosteroids as adjuvant analgesics. J Pain Symptom Manage 9:442–445PubMedCrossRefGoogle Scholar
  94. 94.
    Bruera E, Sweeney C (2004) Pharmacological interventions in cachexia and anorexia. In: Doyle D, Hanks G, Cherny N, Caiman K (eds) Oxford textbook of palliative medicine, 3rd edn. Oxford University Press, New York, pp 552–560Google Scholar
  95. 95.
    Maltoni M, Nanni O, Scarpi E et al (2001) High-dose progestins for the treatment of cancer anorexiacachexia syndrome: a systematic review of randomized clinical trials. Ann Oncol 12:289–300PubMedCrossRefGoogle Scholar
  96. 96.
    Lopez AP, Roquè-i-Figuls M, Urrutia Cuchi G et al (2004) Systematic review of megestrol acetate in the treatment of anorexia-cachexia syndrome. J Pain Symptom Manage 27:360–369CrossRefGoogle Scholar
  97. 97.
    Bruera E, Ernst S, Hagen N et al (1998) Effectiveness of megestrol acetate in patients with advanced cancer: a randomized double blind, crossover study. Cancer Prev Control 2:74–78PubMedGoogle Scholar
  98. 98.
    De Conno F, Martini C, Zecca E et al (1998) Megestrol acetate for anorexia in patients with faradvanced cancer: a double-blind controlled clinical trial. Eur J Cancer 34:1705–1709PubMedCrossRefGoogle Scholar
  99. 99.
    Simons JPFHA, Aaronson NK, Vansteenkiste JF et al (1996) Effects of medroxyprogesterone acetate on appetite, weight and quality of life in advanced-stage non-hormone-sensitive cancer: a placebo-controlled multicentric study. J Clin Oncol 14:1077–1084PubMedGoogle Scholar
  100. 100.
    Vedell C, Segui MA, Gimenez-Arnau JM et al (1998) Anticachectic efficacy of megestrol acetate at different doses and versus placebo in patients with neoplastic cachexia. Am J Clin Oncol 21:347–351CrossRefGoogle Scholar
  101. 101.
    Beller E, Tattersall M, Lumley T et al (1997) Improved quality of life with megestrol acetate in patients with endocrine-insensitive advanced cancer: a randomised placebo-controlled trial. Australasian megestrol acetate cooperative study group. Ann Oncol 8:277–283PubMedCrossRefGoogle Scholar
  102. 102.
    Kornek GV, Schenk T, Ludwig H et al (1996) Placebo-controlled trial of medroxyprogesterone acetate in gastrointestinal malignancies and cachexia. Onkologie 19:164–168CrossRefGoogle Scholar
  103. 103.
    Rowland KM, Loprinzi CL, Shaw EG et al (1996) Randomized double-blind placebo-controlled trial of cisplatin and etoposide plus megestrol acetate/placebo in extensive-stage small-cell lung cancer: a North Central Cancer Treatment Group study. J Clin Oncol 14:135–141PubMedGoogle Scholar
  104. 104.
    Tchekmedyian NS, Hickman M, Siau J et al (1992) Megestrol acetate in cancer anorexia and weight loss. Cancer 69:1268–1274PubMedCrossRefGoogle Scholar
  105. 105.
    Westman G, Bergman B, Albertsson M et al (1999) Megestrol acetate in advanced progressive hormone-insensitive cancer. Effects on the quality of life: a placebo-controlled randomised multicentre trial. Eur J Cancer 35:586–595PubMedCrossRefGoogle Scholar
  106. 106.
    Loprinzi CL, Michalak D, Schaid DJ et al (1993) Phase III evaluation of four doses of megestrol acetate as therapy for patients with cancer anorexia and/or cachexia. J Clin Oncol 11:762–767PubMedGoogle Scholar
  107. 107.
    Feliu J, Gonzalez-Baron M, Berrocal A et al (1992) Usefulness of megestrol acetate in cancer cachexia and anorexia. Am J Clin Oncol 15:436–440PubMedCrossRefGoogle Scholar
  108. 108.
    Schmoll E (1992) Risks and benefit of various therapies for cancer anorexia. Oncology 49:43–45PubMedCrossRefGoogle Scholar
  109. 109.
    Downer S, Joel S, Allbright A et al (1993) A double blind placebo controlled trial of medroxyprogesterone acetate (MPA) in cancer cachexia. Br J Cancer 67:1102–1105PubMedGoogle Scholar
  110. 110.
    Loprinzi CL, Ellison NM, Schaid DJ et al (1990) Controlled trial of megestrol acetate for the treatment of cancer anorexia and cachexia. J Natl Cancer Inst 82:1127–1132PubMedCrossRefGoogle Scholar
  111. 111.
    Neri B, Garosi VL, Intini C (1997) Effect of medroxyprogesterone acetate on the quality of life of the oncologic patient: a multicentric cooperative study. Anticancer Drugs 8:459–465PubMedCrossRefGoogle Scholar
  112. 112.
    Bruera E, MacMillan K, Kuehn N et al (1990) A controlled trial of megestrol acetate on appetite, caloric intake, nutritional status and other symptoms in patients with advanced cancer. Cancer 66:1279–1282PubMedCrossRefGoogle Scholar
  113. 113.
    Jatoi A, Windschitl HE, Loprinzi CL et al (2002) Dronabinol versus megestrol acetate versus combination therapy for cancer-associated anorexia: a North Central Cancer Treatment Group Study. J Clin Oncol 20:567–573PubMedCrossRefGoogle Scholar
  114. 114.
    Cella D, Chang CH, Lai JS et al (2002) Advances in quality of life measurements in oncology patients. Semin Oncol 29(Suppl 8):60–68PubMedCrossRefGoogle Scholar
  115. 115.
    Loprinzi CL, Kugler JW, Sloan JA et al (1999) A randomized comparison of megestrol acetate versus dexamethasone, versus fluoxymesterone for the treatment of cancer anorexia/cachexia. J Clin Oncol 17:3299–3306PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2006

Authors and Affiliations

  • Davide Tassinari
  • Marco Maltoni

There are no affiliations available

Personalised recommendations