The Effect of Cyproheptadine Hydrochloride (Periactin) and Megestrol Acetate (Megace) on Weight in Children With Cancer/Treatment-related Cachexia

Background: Children with cancer frequently have associated cachexia and Malnutrition. Failure to thrive affects nearly, 40%, of oncology patients with advanced or progressive disease. Malnutrition can erode quality of life and adversely impact disease prognosis. Appetite stimulation and increased food intake is 1 approach to combat cancer-related cachexia. Materials and Methods: Cyproheptadine hydrochloride (CH), an appetite stimulant. was administered to children with cancer-associated cachexia to prevent further weight loss. All participants started CH and were evaluated for response after 4 weeks. Efficacy of megestrol acetate (MA) was evaluated in patients who did not respond to CH. Medical evaluation, weight measurements. preablumin, and serum leptin levels were preformed at follow-up visits. Results: Seventy patients were enrolled. Of the 66 evaluable patients. 50 demonstrated a response to CH (average weight gain 2.6 kg and mean weight-for-age z-score change of 0.35, P = 0.001). Seven of the 16 nonresponders received MA. Six patients completed 4 weeks of MA, 5 responded (average weight gain of 2.5 kg). The most commonly reported side effect of CH was drowsiness. One patient on MA developed low, cortisol levels and hyperlipidemia. Conclusions: This Study demonstrates that CH is a safe and effective way to promote weight gain in children with cancer/treatment-related cachexia.