A Systematic Review and Meta-Analysis of the Clinical Use of Megestrol Acetate for Cancer-Related Anorexia/Cachexia
Cancer-related anorexia/cachexia is known to be associated with worsened quality of life and survival; however, limited treatment options exist. Although megestrol acetate (MA) is often used off-label to stimulate appetite and improve anorexia/cachexia in patients with advanced cancers, the benefits...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-06-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/11/13/3756 |
| _version_ | 1797408838123520000 |
|---|---|
| author | Yu Liang Lim Seth En Teoh Clyve Yu Leon Yaow Daryl Jimian Lin Yoshio Masuda Ming Xuan Han Wee Song Yeo Qin Xiang Ng |
| author_facet | Yu Liang Lim Seth En Teoh Clyve Yu Leon Yaow Daryl Jimian Lin Yoshio Masuda Ming Xuan Han Wee Song Yeo Qin Xiang Ng |
| author_sort | Yu Liang Lim |
| collection | DOAJ |
| description | Cancer-related anorexia/cachexia is known to be associated with worsened quality of life and survival; however, limited treatment options exist. Although megestrol acetate (MA) is often used off-label to stimulate appetite and improve anorexia/cachexia in patients with advanced cancers, the benefits are controversial. The present meta-analysis aimed to better elucidate the clinical benefits of MA in patients with cancer-related anorexia/cachexia. A systematic search of PubMed, EMBASE, OVID Medline, Clinicaltrials.gov, and Google Scholar databases found 23 clinical trials examining the use of MA in cancer-related anorexia. The available randomized, controlled trials were appraised using Version 2 of the Cochrane risk-of-bias tool (RoB 2) and they had moderate-to-high risk of bias. A total of eight studies provided sufficient data on weight change for meta-analysis. The studies were divided into high-dose treatment (>320 mg/day) and low-dose treatment (≤320 mg/day). The overall pooled mean change in weight among cancer patients treated with MA, regardless of dosage was 0.75 kg (95% CI = −1.64 to 3.15, τ<sup>2</sup> = 9.35, I<sup>2</sup> = 96%). Patients who received high-dose MA tended to have weight loss rather than weight gain. There were insufficient studies to perform a meta-analysis for the change in tricep skinfold, midarm circumference, or quality of life measures. MA was generally well-tolerated, except for a clear thromboembolic risk, especially with higher doses. On balance, MA did not appear to be effective in providing the symptomatic improvement of anorexia/cachexia in patients with advanced cancer. |
| first_indexed | 2024-03-09T04:04:25Z |
| format | Article |
| id | doaj.art-4264e68717c5407c893361a862b73347 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T04:04:25Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-4264e68717c5407c893361a862b733472023-12-03T14:08:03ZengMDPI AGJournal of Clinical Medicine2077-03832022-06-011113375610.3390/jcm11133756A Systematic Review and Meta-Analysis of the Clinical Use of Megestrol Acetate for Cancer-Related Anorexia/CachexiaYu Liang Lim0Seth En Teoh1Clyve Yu Leon Yaow2Daryl Jimian Lin3Yoshio Masuda4Ming Xuan Han5Wee Song Yeo6Qin Xiang Ng7MOH Holdings Pte Ltd., 1 Maritime Square, Singapore 099253, SingaporeYong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, SingaporeYong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, SingaporeYong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, SingaporeYong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, SingaporeDepartment of Paramedicine, Monash University Peninsula Campus, Frankston, VIC 3199, AustraliaMount Elizabeth Hospital, 3 Mount Elizabeth, Singapore 228510, SingaporeMOH Holdings Pte Ltd., 1 Maritime Square, Singapore 099253, SingaporeCancer-related anorexia/cachexia is known to be associated with worsened quality of life and survival; however, limited treatment options exist. Although megestrol acetate (MA) is often used off-label to stimulate appetite and improve anorexia/cachexia in patients with advanced cancers, the benefits are controversial. The present meta-analysis aimed to better elucidate the clinical benefits of MA in patients with cancer-related anorexia/cachexia. A systematic search of PubMed, EMBASE, OVID Medline, Clinicaltrials.gov, and Google Scholar databases found 23 clinical trials examining the use of MA in cancer-related anorexia. The available randomized, controlled trials were appraised using Version 2 of the Cochrane risk-of-bias tool (RoB 2) and they had moderate-to-high risk of bias. A total of eight studies provided sufficient data on weight change for meta-analysis. The studies were divided into high-dose treatment (>320 mg/day) and low-dose treatment (≤320 mg/day). The overall pooled mean change in weight among cancer patients treated with MA, regardless of dosage was 0.75 kg (95% CI = −1.64 to 3.15, τ<sup>2</sup> = 9.35, I<sup>2</sup> = 96%). Patients who received high-dose MA tended to have weight loss rather than weight gain. There were insufficient studies to perform a meta-analysis for the change in tricep skinfold, midarm circumference, or quality of life measures. MA was generally well-tolerated, except for a clear thromboembolic risk, especially with higher doses. On balance, MA did not appear to be effective in providing the symptomatic improvement of anorexia/cachexia in patients with advanced cancer.https://www.mdpi.com/2077-0383/11/13/3756megestrol acetatemegaceanorexiacancerpalliativequality of life |
| spellingShingle | Yu Liang Lim Seth En Teoh Clyve Yu Leon Yaow Daryl Jimian Lin Yoshio Masuda Ming Xuan Han Wee Song Yeo Qin Xiang Ng A Systematic Review and Meta-Analysis of the Clinical Use of Megestrol Acetate for Cancer-Related Anorexia/Cachexia Journal of Clinical Medicine megestrol acetate megace anorexia cancer palliative quality of life |
| title | A Systematic Review and Meta-Analysis of the Clinical Use of Megestrol Acetate for Cancer-Related Anorexia/Cachexia |
| title_full | A Systematic Review and Meta-Analysis of the Clinical Use of Megestrol Acetate for Cancer-Related Anorexia/Cachexia |
| title_fullStr | A Systematic Review and Meta-Analysis of the Clinical Use of Megestrol Acetate for Cancer-Related Anorexia/Cachexia |
| title_full_unstemmed | A Systematic Review and Meta-Analysis of the Clinical Use of Megestrol Acetate for Cancer-Related Anorexia/Cachexia |
| title_short | A Systematic Review and Meta-Analysis of the Clinical Use of Megestrol Acetate for Cancer-Related Anorexia/Cachexia |
| title_sort | systematic review and meta analysis of the clinical use of megestrol acetate for cancer related anorexia cachexia |
| topic | megestrol acetate megace anorexia cancer palliative quality of life |
| url | https://www.mdpi.com/2077-0383/11/13/3756 |
| work_keys_str_mv | AT yulianglim asystematicreviewandmetaanalysisoftheclinicaluseofmegestrolacetateforcancerrelatedanorexiacachexia AT sethenteoh asystematicreviewandmetaanalysisoftheclinicaluseofmegestrolacetateforcancerrelatedanorexiacachexia AT clyveyuleonyaow asystematicreviewandmetaanalysisoftheclinicaluseofmegestrolacetateforcancerrelatedanorexiacachexia AT daryljimianlin asystematicreviewandmetaanalysisoftheclinicaluseofmegestrolacetateforcancerrelatedanorexiacachexia AT yoshiomasuda asystematicreviewandmetaanalysisoftheclinicaluseofmegestrolacetateforcancerrelatedanorexiacachexia AT mingxuanhan asystematicreviewandmetaanalysisoftheclinicaluseofmegestrolacetateforcancerrelatedanorexiacachexia AT weesongyeo asystematicreviewandmetaanalysisoftheclinicaluseofmegestrolacetateforcancerrelatedanorexiacachexia AT qinxiangng asystematicreviewandmetaanalysisoftheclinicaluseofmegestrolacetateforcancerrelatedanorexiacachexia AT yulianglim systematicreviewandmetaanalysisoftheclinicaluseofmegestrolacetateforcancerrelatedanorexiacachexia AT sethenteoh systematicreviewandmetaanalysisoftheclinicaluseofmegestrolacetateforcancerrelatedanorexiacachexia AT clyveyuleonyaow systematicreviewandmetaanalysisoftheclinicaluseofmegestrolacetateforcancerrelatedanorexiacachexia AT daryljimianlin systematicreviewandmetaanalysisoftheclinicaluseofmegestrolacetateforcancerrelatedanorexiacachexia AT yoshiomasuda systematicreviewandmetaanalysisoftheclinicaluseofmegestrolacetateforcancerrelatedanorexiacachexia AT mingxuanhan systematicreviewandmetaanalysisoftheclinicaluseofmegestrolacetateforcancerrelatedanorexiacachexia AT weesongyeo systematicreviewandmetaanalysisoftheclinicaluseofmegestrolacetateforcancerrelatedanorexiacachexia AT qinxiangng systematicreviewandmetaanalysisoftheclinicaluseofmegestrolacetateforcancerrelatedanorexiacachexia |