The effect of cyproheptadine hydrochloride (periactin) and megestrol acetate (megace) on weight in children with cancer/treatment-related cachexia.

Abstract

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, prealbumin, 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.

• Authors: Marisa Couluris, Jennifer L R Mayer, David R Freyer, Eric Sandler, Ping Xu, Jeffrey P Krischer
• Journal: Journal of pediatric hematology/oncology (J Pediatr Hematol Oncol) Vol. 30 Issue 11 Pg. 791-7 (Nov 2008) ISSN: 1536-3678 [Electronic] United States
• PMID: 18989154 (Publication Type: Clinical Trial, Phase II, Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Appetite Stimulants
• Gastrointestinal Agents
• Cyproheptadine
• Megestrol Acetate

Topics

• Adolescent
• Adult
• Appetite Stimulants (therapeutic use)
• Cachexia (drug therapy, etiology)
• Child
• Child, Preschool
• Cyproheptadine (therapeutic use)
• Female
• Gastrointestinal Agents (therapeutic use)
• Humans
• Male
• Megestrol Acetate (therapeutic use)
• Neoplasm Recurrence, Local (diagnosis, drug therapy)
• Neoplasms (complications, pathology)
• Prognosis
• Quality of Life
• Weight Gain (drug effects)