Megace scientific update |
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J Chemother. 2010 Jun;22(3):201-4.
Licchetta A, Correale P, Migali C, Remondo C, Francini E, Pascucci A, Magliocca A, Guarnieri A, Savelli V, Piccolomini A, Carli AF, Francini G.
Section of Medical Oncology, Department Giorgio Segre of Pharmacology, Siena University School of Medicine, Italy.
Oral metronomic chemo-hormonal-therapy of metastatic breast cancer with cyclophosphamide and megestrol acetate.
Metronomic chemotherapy is an anticancer strategy which uses conventional cytotoxic drugs administered at very low dose in close intervals. We have designed a phase II trial to investigate the safety and antitumor activity of the newest metronomic chemo-hormonal-therapy with daily cyclophosphamide and twice daily megestrol acetate (mCM regimen) in patients with metastatic pretreated breast cancer.Twenty-nine pretreated post-menopausal patients with multiple metastatic sites were enrolled. four patients had a triple negative status, nineteen a positive hormonal ER and PgR status, and three ERB-B2 over-expression. Patients received treatment with cyclophosphamide (50 mg/daily day 1-21/q28) and fractionated megestrol acetate (80 mg twice a day). The overall objective response rate was 31.0%, disease control rate 41.3%, mean time to tumor progression 7.4 months (CI 95%, 3.8-10.88, range 1-48 months) and mean overall survival 13.4 months (CI 95%, 7.24-17.18, range 1-53 months). The mCM regimen was active and well tolerated.
Int J Pharm. 2010 Jun 14. [Epub ahead of print]
Cho E, Cho W, Cha KH, Park J, Kim MS, Kim JS, Park HJ, Hwang SJ.
Center for Nanotechnology-based New Drug Dosage Form, College of Pharmacy, Chungnam National University, 220 Gung-dong, Yuseong-gu, Daejeon 305-764, Korea.
Enhanced dissolution of megestrol acetate microcrystals prepared by antisolvent precipitation process using hydrophilic additives.
Microcrystals of megestrol acetate (MA), a poorly water soluble drug, were successfully prepared using an antisolvent precipitation technique for improving the dissolution rate. The effective hydrophilic polymers and surfactants used were screened for their abilities to produce smaller particle sizes. Raw micronized MA and processed MA microcrystals were ranked by the Student-Newman-Keuls test in order of increasing particle size and SPAN values as follows: processed MA microcrystals in the presence of polymer and surfactant (mean diameter 1048nm)
Se Pu. 2010 Feb;28(2):190-6.
Zhang A, Wang Q, Shen J, Zhang S, Chen L.
Ningbo Academy of Product Quality Supervision & Inspection, Ningbo 315041, China.
[Simultaneous determination of seven sex hormones in fish products using ultra performance liquid chromatography-tandem mass spectrometry] [Article in Chinese]
A rapid, specific and highly sensitive method for the determination of seven sex hormones (norgestrel, methyltestosterone, testosterone propionate, medroxyprogesterone acetate, megestrol acetate, chlormadinone acetate, and nandrolone) residues in fish products was developed using ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) with electrospray ionization (ESI) in positive mode. The target compounds were extracted with methanol after the enzyme hydrolysis of the fish products. ZnCl2 was added to the extract solution to remove lipids. Then target compounds were purified by an LC-C18 and an LC-NH2 solid phase extraction cartridges. The target compounds were separated on a Waters ACQUITY UPLC BEH-C18 column (100 mm x 2.1 mm, 1.7 microm) and detected qualitatively and quantitatively in multi reaction monitoring (MRM) mode. For the seven sex hormones, the limits of detection (LOD) of the method were from 0.08 to 0.17 microg/kg and the limits of quantification (LOQ) were in the range of 0.24 -0.58 microg/kg. At the spiked levels of 1 and 4 microg/kg, the average recoveries ranged from 76% to 118% with the relative standard deviations between 5.0% and 11.3% for the seven sex hormones using internal standard method; and the average recoveries ranged from 66% to 94% with the relative standard deviations between 4.5% and 10.7% using matrix matched external standard method. The results showed that both methods are able to meet the multi-residue detection of the seven sex hormone residues in fish products. The degreased large yellow croaker and roast fish fillet real samples from a local market were detected by the developed method, and the seven targets were not found.
Onkologie. 2010;33(5):260-2. Epub 2010 Apr 21.
Lim MC, Lee S, Seo SS.
Center for Uterine Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, Korea.
Megestrol acetate therapy for advanced low-grade endometrial stromal sarcoma.
BACKGROUND: Pulmonary metastases as an initial presentation of primary uterine low-grade endometrial stromal sarcoma (LGESS) are extremely rare. Optimal treatment for such LGESS has not been established. CASE REPORT: A 30-year-old woman presented with multiple pulmonary metastases on chest X-ray. Chest computed tomography (CT) revealed 11 pulmonary metastases measuring up to 2.8 cm. A uterine mass was detected during the workup and was diagnosed as LGESS by fine needle aspiration. Hysterectomy, right salpingo-oophorectomy, paraaortic and pelvic lymph node sampling, and omentectomy were performed. The left ovary was preserved since the surgery was performed with the aim of palliation and the patient refused to be in surgical menopause. She was then given high-dose megestrol acetate (800 mg/day) for 4 months followed by 200 mg/day for 20 months. The pulmonary metastases of LGESS began to regress with megestrol acetate treatment and almost completely disappeared 17 months after surgery. At this unexpected and satisfactory response to hormonal treatment, the remaining left ovary was also surgically removed. Since the surgery, the patient has been alive without symptomatic pulmonary metastases over 5 years on intermittent treatment of 200 mg megestrol acetate. CONCLUSION: Megestrol acetate could be suitable as the first-line hormonal treatment for pulmonary metastases from LGESS.
Wei Sheng Yan Jiu. 2009 Nov;38(6):740-6.
Wang Q, Zhang A, Chen L.
Ningbo Academy of Product Quality Supervision & Inspection, Ningbo 315041, China. quanlinwang@163.com
[Study on simultaneous determination method for banded synthesis hormones residues in egg products] [Article in Chinese]
OBJECTIVE: To develop method of 7 banded synthesis sex hormones residues in egg products determinated by ultra performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS). METHODS: The sample were enzymolied and target compounds were extracted with methanol. ZnCl2 was added to the extract solution to remove lipid and then analytes were purified by LC-C18 and LC-NH2 solid phase extraction cartridge and further determined by UPLC-MS/MS under positive ionization and multiple reaction monitoring (MRM) modes. RESULTS: The limits of detection (LOD) of UPLC-MS/MS method used for testing Chlormadione acetate (CDA), Medroxypogesterone acetate (MPA), Megestrol Acetate (MA), Testosterone propionate (TSP), Norgestrel (NG), Methyltestosterone (MTS) and Nandrolone (NT) in egg products ranged from 0.012 to 0.23 microg/kg, and the limits of quantification (LOQ) were from 0.04 to 0.76 microg/kg. Experiments on spiked samples of egg products showed that at addition level of 2.0 microg/kg, the average recoveries of the sex hormones ranged from 80.2% to 114%, and coefficients of variation from 6.7% to 14.3%; while at addition level of 4.0 microg/kg, the average recoveries ranged from 75% to 119%, and coefficient of variation from 2.9% to 7.3%. CONCLUSION: The method could be able to identify and quantify banded synthesis hormones residues in eggs and egg products. It could be simple and sensitive, suitable for statutory residue testing.
Acta Biochim Pol. 2009;56(4):733-7. Epub 2009 Dec 8.
Gołebiewska J, Lichodziejewska-Niemierko M, Aleksandrowicz E, Majkowicz M, Lysiak-Szydłowska W, Rutkowski B.
Palliative Medicine Department, Medical University of Gdańsk, Gdańsk, Poland.
Influence of megestrol acetate on nutrition and inflammation in dialysis patients - preliminary results.
Malnutrition is a common clinical problem in dialysis patients. So far the management of malnutrition in this population has not been fully successful. The aim of the study was to evaluate the efficacy and safety of use of megestrol acetate suspension in malnourished dialysis patients. Twenty-six hypoalbuminemic (albumin < or = 3.8 g/dl) dialysis patients took 160 mg of megestrol acetate daily for a period of two months. Anthropometry (dry weight, body mass index) and biochemical measurements of nutrition (serum albumin, triglycerides, total cholesterol) and inflammation (hsCRP, IL-1beta, IL-6) were performed on a monthly basis. The treatment led to a statistically significant increase (P < 0.05) in anthropometry and albumin concentration, with no statistically significant changes in total cholesterol, triglycerides and indices of inflammation. Side effects included overhydration, diarrhoea and hyperglycaemia. Thus, megestrol acetate may be an effective therapeutic agent in improving the nutritional status of carefully selected dialysis patients, while it might not mitigate inflammation. Because of the prevalent side effects it must be monitored closely.
J Soc Integr Oncol. 2009 Fall;7(4):155-69.
Gullett N, Rossi P, Kucuk O, Johnstone PA.
Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, USA.
Cancer-induced cachexia: a guide for the oncologist.
Cancer-induced cachexia (CIC) is a paraneoplastic syndrome that may account for up to 20% of deaths in cancer patients. Cachexia includes distinct metabolic changes that are the result of an acute-phase response (APR) mounted by the host as a reaction to tumor cells. These changes include increased muscle proteolysis, increased fat lipolysis, and increased hepatic production of acute-phase proteins such as C-reactive protein and fibrinogen. This APR pathogenesis is an important consideration in trying to treat cachectic patients as most therapies do not target the APR and its subsequent metabolic effects. Although there is currently no cure for CIC, the oncologist frequently encounters cachectic patients in practice, and evidence-based management is needed. We review the current data for assessment of starvation and cachexia, providing guidelines for management that include serum markers and functional assessment. In addition, a review of current therapies is provided, including hypercaloric feeding and nutritional intervention to address starvation, as well as data on appetite stimulants such as corticosteroids and megestrol acetate. Experimental therapies are also discussed, including nonsteroidal antiinflammatory drugs, tumor necrosis factor alpha antagonists, tetrahydrocannabinol, growth hormone, ghrelin, oxandrolone, and omega-3 fatty acids.
Maturitas. 2008 Sep-Oct;61(1-2):171-80.
Schindler AE, Campagnoli C, Druckmann R, Huber J, Pasqualini JR, Schweppe KW, Thijssen JH.
Institut für Medizinische Forschung und Fortbildung, Universitätsklinikum, Hufelandstr. 55, Essen 45147, Germany.
Classification and pharmacology of progestins.
Besides the natural progestin, progesterone, there are different classes of progestins, such as retroprogesterone (i.e. dydrogesterone), progesterone derivatives (i.e. medrogestone) 17alpha-hydroxyprogesterone derivatives (i.e. chlormadinone acetate, cyproterone acetate, medroxyprogesterone acetate, megestrol acetate), 19-norprogesterone derivatives (i.e. nomegestrol, promegestone, trimegestone, nesterone), 19-nortestosterone derivatives norethisterone (NET), lynestrenol, levonorgestrel, desogestrel, gestodene, norgestimate, dienogest) and spironolactone derivatives (i.e. drospirenone). Some of the synthetic progestins are prodrugs, which need to be metabolized to become active compounds. Besides the progestogenic effect, which is in common for all progestins, there is a wide range of biological effects, which are different for the various progestins and have to be taken into account, when medical treatment is considered.
Med Pregl. 2008 Nov-Dec;61(11-12):571-5.
Sarcev T, Secen N, Sabo A, Povazan D.
Medicinski fakultet Novi Sad, Institut za plućne bolesti Vojvodine Sremska Kamenica.
[Influence of dexamethasone on appetite and body weight in lung cancer patients] [Article in Serbian]
INTRODUCTION: Anorexia and cachexia are the most common symptoms in cancer patients. They increase morbidity and mortality among cancer patients as well as complications of surgery, radiotherapy and chemotherapy. The most common drugs for treatment of cancer cachexia are corticosteroids and megestrol acetate. MATERIAL AND METHODS: The purpose of this study was to determine the influence of dexamethasone on appetite loss and weight loss in lung cancer patients treated with chemotherapy. Group A (30 patients) was treated with cisplatin, etoposide and standard supportive therapy, while group B (30 patients) received, in addition to this treatment, dexamethasone in the dose of 8 mg intravenously per day (1-3 day of chemotherapy). RESULTS: There was a statistically significant difference in appetite loss between two groups after the second chemotherapy cycle favouring group A. The analysis of weight loss showed a statistically significant difference between two groups after both chemotherapy cycles, once again in favour of group A. Concerning the impovement of appetite and weight gain, there was no statistically significant difference between two groups after both chemotherapy cycles. DISCUSSION: Many double-blind randomized controlled studies showed beneficial symptomatic effect of corticosteroids in cancer cachexia, especially on the improvement of appetite, food intake and performance status. In most of the studies the weight gain was not recorded The most effective type of corticosteroids, dose and route of administration have not been established. CONCLUSION: Dexamethasone significantly decreases appetite loss and weight loss in lung cancer patients treated with chemotherapy, while it has no influence on appetite impovement and weight gain.
Pol Arch Med Wewn. 2008 Nov;118(11):636-44.
Leśniak W, Bała M, Jaeschke R, Krzakowski M.
Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland. lesniak@mp.pl
Effects of megestrol acetate in patients with cancer anorexia-cachexia syndrome--a systematic review and meta-analysis.
INTRODUCTION: Anorexia-cachexia syndrome (ACS) often occurs in patients with advanced cancer. OBJECTIVES: To review the effect of megestrol acetate (MA) in patients with ACS. PATIENTS AND METHODS: To identify eligible studies, systematic review by Lopez et al. (2004) was used, electronic databases (MEDLINE, EMBASE and CENTRAL) were searched and reference lists of included studies were reviewed. The studies were included in the review if they were randomized, enrolled patients with non-hormone-sensitive cancer and ACS and assessed the effects of MA compared with placebo, other drugs or different doses of MA. RESULTS: The study population is characterized by high mortality and progressive weight loss irrespective of the treatment. Compared to placebo, the effect of MA on survival is similar, but MA increases appetite (number needed to treat [NNT]: 3) and leads to weight gain (NNT: 8) in more patients. The data on other aspects of the quality of life are limited. The comparison of MA and glucocorticosteroids showed no statistical difference in their effect on appetite and weight. CONCLUSIONS: Compared to placebo, MA reduces the symptoms of ACS, with no effect on survival. The beneficial effect of MA on the overall quality of life has not been confirmed. In identified studies the effect of MA and glucocorticosteroids on anorexia and cachexia is similar. The estimation of the treatment utility in ACS depends on the weight attributed to discomfort caused by symptoms, adverse effects of the drugs and the treatment cost. Because of the low quality of the included studies a new randomized controlled trial is needed for valid assessment of the effects of MA.
Eur J Gynaecol Oncol. 2008;29(6):661-3.
Topuz S, Kalelioğlu I, Iyibozkurt C, Ergun B.
Department of Obstetrics and Gynecology, Istanbul University, School of Medicine, Turkey. samettopuz@yahoo.com
Conservative management of a patient with endometrial carcinoma desiring fertility: how to inform?
Conservative management of patients with endometrial cancer who desire fertility is becoming widespread in certain circumstances. A 36-year-old women desiring fertility with early-stage endometroid type adenocarcinoma of the endometrium was treated with 160 mg/d megestrol acetate for six months. After confirmation of a normal endometrial biopsy she became pregnant spontaneously. Following an uneventful pregnancy a healthy baby at term was delivered by cesarean section. Definitive surgery was performed. The risks and benefits of this thereupeutic approach are discussed and informing style of the patients emphasized.
Lijec Vjesn. 2007 Dec;129(12):381-6.
Krznarić Z, Juretić A, Samija M, Dintinjana RD, Vrdoljak E, Samarzija M, Kolacek S, Vrbanec D, Prgomet D, Ivkić M, Zelić M; Croatian Society of Parenteral and Enteral Nutrition, Croation Society of Oncology, Croation society of Me
KBC Zagreb, Klinika za tumore, Zagreb. zeljko.krznaric1@zg.t-com.hr
[Croatian guidelines for use of eicosapentaenoic acid and megestrol acetate in cancer cachexia syndrome] [Article in Croatian]
Among many oncological patients we can notice a substantial loss of body weight, fat and proteins with significant proinflammatory activity at the time of diagnosis. This wasting condition is well known as cancer cachexia syndrome. Anorexia is important part of this syndrome. Because cancer cachexia reduces tumor response to treatment and it is an indicator of poor prognosis, we need to start correcting these nutritional deficits at once. In the presence of cancer cachexia it is extremely difficult to achieve protein anabolism and stop the body wasting by standard nutritional formulas only. During the last few years, the use of eicosapentaenoic acid (EPA) and megestrol acetate (MA) as anticahectic agents has been tested. These guidelines are intended to give evidence-based recommendations for the use of eicosapentaenoic acid and megestrol acetate in cancer cachexia syndrome. These guidelines have been developed by interdisciplinary expert group of Croatian clinicians. Based on relevant literature, we have concluded that the use of metabolic modulators such as eicosapentaenoic acid and megestrol acetate for 8 weeks may help to improve nutritional status in cachectic patients.
Curr Pharm Des. 2007;13(35):3637-47.
Morley JE.
Division of Geriatric Medicine, Saint Louis University Medical Center, St. Louis, MO 63104, USA. morley@slu.edu
Weight loss in older persons: new therapeutic approaches.
There is now a large body of evidence that weight loss in older persons not only increases mortality, but also increases the incidence of hip fracture, functional deterioration and institutionalization. Weight loss is a central component of frailty. There is evidence that it is not only muscle, but also fat loss that leads to these deleterious effects. The reasons why fat loss can be harmful in older persons are reviewed. There are four major causes of weight loss in older persons viz. anorexia, sarcopenia, cachexia and dehydration. This review concentrates on the major causes of anorexia and sarcopenia. In particular, the emergence of new medications such as selective androgen receptor molecules, antimyostatin analogues, megestrol acetate (nanocrystal formulation), and ghrelin agonists are reviewed. The potential role of anabolic steroids is also discussed.
Arq Bras Endocrinol Metabol. 2007 Nov;51(8):1245-52.
Vassiliadi D, Tsagarakis S.
Department of Endocrinology, Division of Medical Sciences, Institute of Biomedical Research, University of Birmingham, Birmingham, UK.
Unusual causes of Cushing's syndrome.
Although in the majority of the patients with Cushing's syndrome (CS), hypercortisolism is due to ACTH hypersecretion by a pituitary tumour or to ectopic ACTH secretion from an extrapituitary neoplastic lesion or to autonomous cortisol secretion by an adrenal tumour, in occasional patients a much rarer entity may be the cause of the syndrome. Herein, we attempted to summarise and categorise these unusual causes according to their presumed aetiology. To this end, we performed a comprehensive computer-based search for unusual or rare causes of CS. The following unusual forms of CS were identified: (i) ACTH hyperesecretion due to ectopic corticotroph adenomas in the parasellar region or the neurohypophysis, or as part of double adenomas, or gangliocytomas; (ii) ACTH hypersecretion due to ectopic CRH or CRH-like peptide secretion by various neoplasms; (iii) ACTH-independent cortisol hypersecretion from ectopic or bilateral adrenal adenomas; (iv) glucocorticoid hypersensitivity; (v) iatrogenic, due to megestrol administration or to ritonavir and fluticasone co-administration. Such unusual presentations of CS illustrate why Cushing's syndrome represents one of the most puzzling endocrine syndromes.
Gynecol Endocrinol. 2007 Oct;23 Suppl 1:45-52.
Thijssen JH.
University Medical Centre Utrecht, Utrecht, The Netherlands. J.Thijssen@umcutrecht.nl
Long-term effects of progestins on bone quality and fractures.
The effects of progestins on the quality of bone and their influence on the risk of fractures are reviewed. Data discussed are based on experimental studies in vivo that generally lasted for longer than one year. Information is given on the background of osteoporosis and on several means of inducing changes in bone quality. In young women who start using oral contraceptives based on progestins alone shortly after pubertal development, a significant decrease in bone quality has been documented. World Health Organization experts have concluded that this is not a real argument for restrictions on the use of these contraceptives. In postmenopausal women, no evidence has been found for a bone-protective or an estrogen-antagonistic effect of progestins. A wide range of estrogens have been used that have shown positive effects on bone, which are not antagonized by progestins. The therapeutic use of high-dose megestrol acetate may result in marked negative effects on bone, leading to severe osteoporosis, possibly due to the inherent glucocorticoid activity of this progestin. Other pharmacotherapeutic agents that can be used in postmenopausal therapy, and that clearly have beneficial effects on bone, are discussed.
J Hum Nutr Diet. 2007 Dec;20(6):526-37.
Chinuck RS, Fortnum H, Baldwin DR.
Adult Cystic Fibrosis Centre, David Evans Centre, Nottingham University Hospitals, City Campus, Nottingham, UK.
Appetite stimulants in cystic fibrosis: a systematic review.
BACKGROUND: The use of appetite stimulants in cystic fibrosis (CF) is controversial because of doubts concerning efficacy and side-effects. The aim of the review was to establish whether appetite stimulants should be recommended in CF. MATERIALS AND METHODS: Medline, AMED, British Nursing Index, Cinahl, Embase, The Cochrane Library, National Research Register and Google were searched. Unpublished studies, case reports and conference abstracts were sought from experts, including authors of identified published articles, and suppliers of appetite stimulants. RESULTS: Fifty-four articles were located. Fifteen studies were suitable for inclusion in the review: 10 studied, megesterol acetate (MA); 1, dronabinol; 2, mirtazapine; and 2, cyproheptadine. MA showed a beneficial effect on lung function, weight, appetite, fat free and fat mass. Adverse effects for MA included adrenal suppression, abnormalities of glycaemic control, mood changes and testicular failure. There was no consistency in the dose, frequency and duration of therapy for MA. CONCLUSIONS: The review shows MA may have a role in the management of anorexia associated with CF. It is not possible to be conclusive for the other agents given the low numbers in the studies. Larger randomized, controlled trials of MA are necessary to confirm its safety and validate efficacy in CF.
Am J Cardiol. 2008 Jun 2;101(11A):89E-103E.
Kalantar-Zadeh K, Anker SD, Horwich TB, Fonarow GC.
Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Center at Harbor-UCLA, Torrance, California 90509-2910, USA.
Nutritional and anti-inflammatory interventions in chronic heart failure.
The current study revealed that understanding the factors that modulate malnutrition-inflammation-cachexia (MIC) and body wasting and their associations with clinical outcomes in chronic heart failure (CHF) may lead to the development of nutritional strategies that alter the pathophysiology of CHF and improve outcomes. For this megesterol acetate or pentoxyphylline, may be appropriate adjuncts to dietary supplementation.
Currently, there are 5 million individuals with chronic heart failure (CHF) in the United States who have poor clinical outcomes, including high death rates. Observational studies have indicated a reverse epidemiology of traditional cardiovascular risk factors in CHF; in contrast to trends seen in the general population, obesity and hypercholesterolemia are associated with improved survival. The temporal discordance between the overnutrition (long-term killer) and undernutrition (short-term killer) not only can explain some of the observed paradoxes but also may indicate that malnutrition, inflammation, and oxidative stress may play a role that results in protein-energy wasting contributing to poor survival in CHF. Diminished appetite or anorexia and nutritional deficiencies may be both a cause and a consequence of this so-called malnutrition-inflammation-cachexia (MIC) or wasting syndrome in CHF. Neurohumoral activation, insulin resistance, cytokine activation, and survival selection-resultant genetic polymorphisms also may contribute to the prominent inflammatory and oxidative characteristics of this population. In patients with CHF and wasting, nutritional strategies including amino acid supplementation may represent a promising therapeutic approach, especially if the provision of additional amino acids, protein, and energy includes nutrients with anti-inflammatory and antioxidant properties. Regardless of the etiology of anorexia, appetite-stimulating agents, especially those with anti-inflammatory properties such as megesterol acetate or pentoxyphylline, may be appropriate adjuncts to dietary supplementation. Understanding the factors that modulate MIC and body wasting and their associations with clinical outcomes in CHF may lead to the development of nutritional strategies that alter the pathophysiology of CHF and improve outcomes.
Chang Gung Med J. 2008 Jan-Feb;31(1):102-6.
Wu HM, Lai CH, Huang HY, Wang HS, Soong YK.
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Chang Gung University College of Medicine, Gueishan Township, Taoyuan, Taiwan, ROC.
A successful live twin birth by in vitro fertilization after conservative treatment of recurrent endometrial cancer.
After the development of endometrial cancer, successful pregnancy is rare. The following experiment revealed that recurrent endometrial adenocarcinoma was documented using hysteroscopy and direct endometrial biopsy in a woman. After that a course of Megace therapy was administered and a successful pregnancy occurred after long-term medical treatment and in vitro fertilization-embryo transfer (IVF-ET).
Endometrial cancer is predominately a postmenopausal disease. Endometrial cancer in women of childbearing age is relatively unusual. Endometrial cancer is typically treated with hysterectomy. After the development of endometrial cancer, successful pregnancy is rare. We present a case of recurrent stage I endometrial adenocarcinoma in a 35-year-old woman. Magnetic resonance imaging (MRI) revealed endometrial lesions without myometrium invasion and no pelvic lymph node enlargement. The patient refused surgical intervention with abdominal hysterectomy and bilateral salpingo-oophorectomy because of her essential desire for children. Fertility-preserving medical therapy with megestrol acetate for 1 year and subsequent assisted reproductive treatment (ART) were performed. Successful pregnancy occurred after in vitro fertilization-embryo transfer (IVF-ET). On the basis of these observations and the low malignant potential of well-differentiated endometrial carcinoma, fertility-preserving treatment using Megace therapy was suggested. In this case, recurrence occurred after the completion of Megace therapy and three failed attempts at artificial insemination by the husband (AIH). Recurrent endometrial adenocarcinoma was documented using hysteroscopy and direct endometrial biopsy. Another course of Megace therapy was administered due to her desire for children. A successful pregnancy occurred after long-term medical treatment and IVF-ET.
Int J Nanomedicine. 2006;1(4):411-6.
Yeh SS, Schuster MW.
Northport VAMC, Geriatric division, Northport, NY 11768, USA.
Megestrol acetate in cachexia and anorexia.
The present review explains that nanocrystal formation of megestrol acetate (MA) can better deliver this potent medication for the treatment of cachexia.
The aim is to review major clinical trials that have used megestrol acetate (MA) in the treatment of cachexia across several disease states. A review of general usage and potential side-effects are discussed. A theory that the newly approved nanocrystal formation of MA can better deliver this potent medication for treatment will also be reviewed.
Cancer. 2007 Sep 15;110(6):1173-7.
Dev R, Del Fabbro E, Bruera E.
Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-4009, USA.
Association between megestrol acetate treatment and symptomatic adrenal insufficiency with hypogonadism in male patients with cancer.
According to the present review, clinicians need an increased awareness of the complication of adrenal insufficiency secondary to megestrol acetate (MA) treatment and a low threshold to test for adrenal and gonadal dysfunction in symptomatic male patients with advanced cancer.
Patients with advanced cancer may develop cachexia, which is often treated with megestrol acetate (MA). In addition to thromboembolic disease, MA may cause symptomatic suppression of the hypothalamic pituitary adrenal axis. In male patients with cancer, treatment with MA may also suppress the gonadal axis, resulting in symptomatic androgen deficiency. Three cases are presented to highlight the symptomatic burden of adrenal insufficiency and hypogonadism. Clinicians need an increased awareness of the complication of adrenal insufficiency secondary to MA treatment and a low threshold to test for adrenal and gonadal dysfunction in symptomatic male patients with advanced cancer.
Clin Nutr. 2006 Oct;25(5):711-5.
Mateen F, Jatoi A.
Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Megestrol acetate for the palliation of anorexia in advanced, incurable cancer patients.
The present review summarizing the findings and providing a practical approach for prescribing megestrol acetate to advanced cancer patients who suffer from the cancer anorexia/weight loss syndrome.
Anorexia, or loss of appetite, is a troubling symptom for many patients with advanced cancer. The early observation that breast cancer patients, who were prescribed megestrol acetate as a cancer treatment, went on to increase their appetite and gain weight has given rise to a large number of clinical trials that have tested this progestational drug as a palliative agent for the cancer anorexia/weight loss syndrome. This review focuses on these trials, summarizing their findings and providing a practical approach for prescribing megestrol acetate to advanced cancer patients who suffer from the cancer anorexia/weight loss syndrome.
Nutr Clin Pract. 2004 Aug;19(4):395-402.
Mwamburi DM, Gerrior J, Wilson IB, Chang H, Scully E, Saboori S, Miller L, Forfia J, Albrecht M, Wanke CA.
Tufts-New England Medical Center, Division of Geographic Medicine and Infectious Diseases, Boston, MA, 02111, USA.
Combination megestrol acetate, oxandrolone, and dietary advice restores weight in human immunodeficiency virus.
Here the scientists examined changes in total body weight (TBW) and health-related quality of life (HRQL) during prolonged combination weight-gaining therapy and dietary advice in HIV. It concluded that prolonged combination therapy with megestrol acetate, oxandrolone, and dietary advice could reverse weight loss and low body mass index (BMI) associated with incomplete viral suppression and improve physical health.
BACKGROUND: We examined changes in total body weight (TBW) and health-related quality of life (HRQL) during prolonged combination weight-gaining therapy and dietary advice in HIV. Design: This was a cohort study of patients initially randomized to single agent therapy for 2 months, megestrol acetate (800 mg daily), or oxandrolone (10 mg twice daily), followed by both agents and dietary advice for 5 months. METHODS: Two community health clinics and 1 urban infectious disease clinic were included, as were HIV-positive adult patients receiving highly active antiretroviral therapy with documented 5% weight loss. TBW and HRQL were measured after 7 months (7 m). RESULTS: Twenty-nine of 39 participants completed 7 m. The average sample age was 40 years, 75% were male, and 52% were of color at enrollment. Baseline mean TBW and body mass index (BMI) were 62.5 kg and 21 kg/m(2), respectively. Net gains in TBW, lean body mass, and fat during the 7 m were 5.3 kg (8.5% of baseline), 2.1 kg, and 3.1 kg, respectively (p < .01 for each). BMI increased to 23.1 kg/m(2) (p < .01). Dietary intake increased by 467 kcal/day (p = .03). Physical health improved by 5.7 (100-point scale, p < .01), and mental health was unchanged (-4.2, p = .11). In multivariable models, female gender (p < .01), lower baseline HIV viral load (p = .03), and increasing age (p < .01) were associated with TBW gain. Injection drug use (p < .01) and higher baseline HIV viral load (p < .01) were associated with reduction in physical health. CONCLUSIONS: Prolonged combination therapy with megestrol acetate, oxandrolone, and dietary advice could reverse weight loss and low BMI associated with incomplete viral suppression and improve physical health.
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