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Am Fam Physician. 2002;66(8):1548

Although anorexia related to advanced cancer is a common problem, few adequate treatments are available. Megestrol acetate is a semisynthetic progesterone that has been used to treat hormone-sensitive cancers. One of the more common side effects of this therapy is weight gain. Previous experience with megestrol in large dosages shows that most patients cannot tolerate this medication because of its adverse effects. Therefore, high dosages of megestrol (800 mg per day) have limited success in treating anorexia related to advanced cancers. Nelson and associates studied the impact of low-dose megestrol on anorexia symptoms in patients with debilitating cancers.

Patients with anorexia caused by advanced cancers were included in the study. Patients whose life expectancy was less than four weeks and those who were severely debilitated, diagnosed with breast or prostate cancer, receiving hormonal or cytotoxic chemotherapy, or who had a significant comorbid illness were excluded. Participants were treated with megestrol acetate in a dosage of 80 mg twice a day with food. At two weeks, patients filled out a questionnaire that asked about appetite, satisfaction with the medication, and whether the patient wished to continue taking the medication. Information concerning side effects was also gathered. Appetite improvement of one degree on the scale was considered a positive response to megestrol.

Twenty patients participated in the study. The median age of the participants was 68 years, and the most common diagnosis was lung cancer. Fifteen patients had a positive appetite response to low-dose megestrol. Of the five nonresponders, four had no further decline of their appetite status, and the fifth could not say how her appetite had changed. The majority of patients were satisfied with their response to megestrol. The only major side effect in the study group was the development of vaginal bleeding and deep venous thrombosis (DVT) in one patient. The DVT was believed to represent a progression of her disease and not a side effect of the megestrol.

The authors conclude that low-dose megestrol acetate is effective in treating anorexia related to advanced cancer. The low dosage of 80 mg twice a day with food improves appetite in these patients with minimal side effects.

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