FPIN's Clinical Inquiries

Megestrol for Palliative Care in Patients with Cancer

 

Am Fam Physician. 2020 May 1;101(9):online.

Clinical Question

Does the benefit of megestrol (Megace) outweigh the risks in patients with cancer?

Evidence-Based Answer

Megestrol may be considered as a component of palliative care nutritional support in patients with cancer. (Strength of Recommendation [SOR]: C, based on expert opinion.) Megestrol improves appetite in patients with anorexia-cachexia syndrome but does not improve quality of life. (SOR: B, based on a meta-analysis of heterogeneous randomized controlled trials [RCTs].) Megestrol is associated with an increased risk of venous thromboembolic events (VTE) when given during chemotherapy. (SOR: C, based on a cohort study with historical control.) It may increase the risk of symptomatic adrenal suppression. (SOR: C, based on a case report.)

Evidence Summary

A 2018 systematic review examined the effectiveness of megestrol for treatment of anorexia-cachexia syndrome in patients with multiple causes of cachexia, including cancer.1 All trials compared megestrol, 160 to 320 mg per day, with placebo for 14 to 126 days. Primary outcomes included improved appetite, as measured by weight gain, and quality of life, as measured by multiple validated tools. Researchers converted outcomes to a standardized mean difference (SMD), where a magnitude of 0.2 was considered small, 0.6 moderate, 1.2 large, and 2.0 very large. Four RCTs included patients with only cancer (n = 250, primarily adults). Megestrol therapy resulted in more weight gain than placebo (mean gain: 5.25 lb [2.38 kg]; 95% CI, 2.20 to 8.16 lb [1.0 to 3.7 kg]), but it did not improve quality of life (two trials, n = 99; SMD = −3.9; 95% CI, −14 to 6.3). Megestrol was similar to placebo in terms of adverse outcome rates (two trials, n = 101; relative risk [RR] = 0.9; 95% CI, 0.39 to 2.08) and mortality (two trials, n = 90; RR = 1.01; 95% CI, 0.42 to 2.45). The included trials had high heterogeneity (I2 = 68%), but randomization protocols and allocation concealment were unclear.

A retrospective cohort study evaluated the

Address correspondence to Jon O. Neher, MD, at jon_neher@valleymed.org. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

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1. Ruiz-Garcia V, Lopez-Briz E, Carbonell-Sanchis R, et al. Megestrol acetate for cachexia-anorexia syndrome. A systematic review. J Cachexia Sarcopenia Muscle. 2018;9(3):444–452....

2. Ordu C, Pilanci KN, Koksal UI, et al. Can megestrol acetate induce thrombosis in advanced oncology patients receiving chemotherapy? Asian Pac J Cancer Prev. 2014;15(23):10165–10169.

3. Dev R, Del Fabbro E, Bruera E. Association between megestrol acetate treatment and symptomatic adrenal insufficiency with hypogonadism in male patients with cancer. Cancer. 2007;110(6):1173–1177.

4. Clinical nutrition guidelines of the French Speaking Society of Clinical Nutrition and Metabolism (SFNEP): summary of recommendations for adults undergoing non-surgical anticancer treatment. Dig Liver Dis. 2014;46(8):667–674.

Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (https://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to https://www.fpin.org or email: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of FPIN's Clinical Inquiries published in AFP is available at https://www.aafp.org/afp/fpin.

 

 

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