Anorexia and
cachexia are major problems in patients with
cancer. Such measures as anti-
cancer therapy, dietary counselling or hyperalimentation are not very successful in reversing this phenomenon in the vast majority of
cancer patients. Thus, several drugs have been evaluated as agents to ameliorate
cancer-associated
anorexia/
cachexia.
Cyproheptadine is an antiserotonergic
drug which appears to cause slight appetite stimulation in patients. A randomised clinical trial, however, was unable to demonstrate any
weight gain from this agent.
Corticosteroids are frequently used in clinical practice for appetite stimulation in patients with advanced
malignancies. Supporting this practice, 4 randomised clinical trials showed that
corticosteroid medications can stimulate the appetites of advanced
cancer patients. However, these studies were not able to show any substantial nonfluid
weight gain in treated patients.
Megestrol acetate is a
progestational agent which appears to be a relatively potent appetite stimulant. Randomised studies in advanced
cancer patients have shown both substantial appetite stimulation and improvement in the nonfluid bodyweights of patients receiving this
drug. Preliminary evidence also suggests that this
drug has
antiemetic properties. Several clinical studies are currently ongoing to determine the effect of various doses of
megestrol acetate in patients with
cancer. Efforts are also ongoing to evaluate both
anabolic steroids and
hydrazine sulfate as drugs for the treatment of patients with
cancer anorexia/
cachexia. The preliminary nature of these investigations, however, precludes recommendations for the use of either of these latter 2 drugs in routine clinical practice.