Radiation Oncology/Cachexia

Treatment

These medications treat the loss of appetite and weight loss but do not treat the cachexia itself.

Medications:

• Corticosteroids:
  • Stimulate appetite, but effect lasts only for 4-8 weeks, and does not lead to weight gain.
• Dronabinol (Marinol)
  • Stimulates appetite but does not clearly lead to weight gain
• Megestrol (Megace)
  • Most potent
• Anabolic steroids: nandrolone, fluoxymesterone, oxandrolone (increases lean tissue mass)

Nutritional supplements:

• Boost, Ensure, etc.
  • Boost (Website) - 240 Cal per 8 oz can. Boost Breeze - 160 Cal (8 oz).
  • Boost Plus - 360 Cal (8 oz)
  • Boost High Protein - 240 Cal (8 oz), 15 g protein
  • Ensure (Website) - 250 Cal (8 oz).
  • Ensure Plus - 350 Cal (8 oz)
  • Ensure High Protein - 230 Cal (8 oz)
• ProSure - Website
  • eicosapentaenoic acid (an omega-3 fatty acid) + protein + calories.
  • Provides 300 Cals (17 g protein) per can.
  • Use 2 cans per day.
  • Does not require prescription.
• Juven - Website
  • HMB (beta-hydroxy-beta-methylbutyrate), arginine and glutamine.
  • Use: 2 servings per day (one packet per serving). Provides 150 Cal/day (75 Cal/pkg).
  • Does not require prescription

Exercise:

• Weight training

Studies

Randomized:

Corticosteroids vs Megesterol

• Mayo, 1999 (1992-96) - PMID 10506633 — "Randomized comparison of megestrol acetate versus dexamethasone versus fluoxymesterone for the treatment of cancer anorexia/cachexia." Loprinzi CL et al. J Clin Oncol. 1999 Oct;17(10):3299-306.
  • 475 pts. Similar efficacy for decadron (0.75 mg qid) and megace (800 mg qd = 5x160), but differing toxicities.