Megestrol acetate:: a systematic review usefulness about the weight gain in neoplastic patients with cachexia

BACKGROUND: The clinical efficacy of megestrol acetate in the treatment of cachexia in cancer patients has not been clearly demonstrated. A systematic review and meta-analysis have been performed to ascertain its effectiveness on weight gain in patients with cancer-associated cachexia. MATERIAL AND METHOD: A systematic review of randomized clinical trials comparing megestrol acetate with placebo in cancer patients was performed. The outcome measure used was weight gain expressed as the difference in weight at the outset compared with that at the end of treatment. Trials analyzed were those that allowed for this calculation, or those whose authors provided information for the above calculation. RESULTS: Patients treated with placebo had an average weight loss of -1.090 kg (CI 95%, -1.620 to -0.561), whereas patients treated with megestrol acetate gained an average 0.423 kg (CI 95%, 0.078-0.769). A weight gain of 0.448 kg (CI 95%, 0.021-0.874) was observed with acetate megestrol doses less than or equal to240 mg. No statistically significant effect was observed when using higher doses: 0.358 kg (CI 95%, -0.135-0.85). CONCLUSIONS: Megestrol acetate doses equal to or lower than 240 mg/day lead to slight weight gain in patients with cancer-associated cachexia. The majority of studies have a low methodological quality. Further, well-designed studies comparing megestrol acetate with placebo are warranted.