Journal Article
. 2004 Apr; 12(7):503-10.
doi: 10.1007/s00520-004-0615-4.

Assessment of gastrointestinal function and response to megesterol acetate in subjects with gastrointestinal cancers and weight loss

John Deutsch 1 J Fred Kolhouse  
Affiliations
  • PMID: 15064933
  •     28 References
  •     3 citations

Abstract

Background: Cancer-associated anorexia/cachexia syndrome (CACS) is common in advanced gastrointestinal malignancies and felt to be due primarily to cytokine-induced appetite suppression. Therapy with an appetite stimulant (megesterol acetate) is commonly employed, but results are sometimes disappointing. We hypothesize that CACS not only suppresses appetite but also interferes with gastrointestinal function.

Methods: We conducted a prospective study in which 21 subjects with advanced gastrointestinal cancer and weight loss had digestive function. Patients were assessed using an indirect stable isotope method, and nutritional parameters were determined following which patients were treated with megesterol acetate for 4 weeks. Nutritional parameters were then reassessed, weight change determined, and the results were correlated with digestive function results obtained at the initiation of the study.

Results: Abnormal gastrointestinal function based on the stable isotope test was common (86% of patients). The majority of the abnormal function appeared to be due to abnormal pancreatic function testing, in which 17/21 subjects recorded low results. Initial albumin, prealbumin, and carotene values were also frequently abnormal (55-65% of patients). Megesterol acetate therapy resulted in a weight gain in most (75%) patients, although serum albumin fell modestly in the group (average decrease of 0.2 mg/dl). However, prealbumin levels rose in 70% and carotene levels rose in 55%. The degree of weight gain was negatively correlated with previous self-reported weight loss ( r=-0.53, p<0.05), and positively correlated ( p<0.05) with pretherapy carotene ( r=0.58), prealbumin ( r=0.61) and the pancreatic function (digestive) phase of the digestive function test ( r=0.41).

Conclusion: These data suggest that abnormal digestive function is commonly seen in subjects with CACS and advanced gastrointestinal cancer, and that both pretherapy digestive function and nutritional status can predict or possibly influence the outcome of hormonal appetite stimulation therapy.

[Megestrol in the treatment of AIDS associated cachexia. Evaluation by bioelectric impedance analysis of body composition].
C Pérez De Oteyza, A García Cortés, +3 authors, M Carnicero Bujarrabal.
An Med Interna, 1998 Jun 18; 15(5). PMID: 9629772
Pathogenesis of cancer cachexia.
Michael J Tisdale.
J Support Oncol, 2004 Sep 01; 1(3). PMID: 15334872
Review.
D-xylose testing.
R M Craig, E D Ehrenpreis.
J Clin Gastroenterol, 1999 Sep 09; 29(2). PMID: 10478874
Review.
A prospective randomized study of megestrol acetate and ibuprofen in gastrointestinal cancer patients with weight loss.
D C McMillan, S J Wigmore, +3 authors, C S McArdle.
Br J Cancer, 1999 Feb 23; 79(3-4). PMID: 10027319    Free PMC article.
Retroperitoneal leiomyosarcoma and gastroparesis: a new association and review of tumor-associated intestinal pseudo-obstruction.
E Lautenbach, G R Lichtenstein.
Am J Gastroenterol, 1995 Aug 01; 90(8). PMID: 7639243
Review.
Bentiromide test is not affected in patients with small bowel disease or liver disease.
B M Meyer, D R Campbell, C W Curington, P P Toskes.
Pancreas, 1987 Jan 01; 2(1). PMID: 3494995
New drugs for the anorexia-cachexia syndrome.
Mellar P Davis.
Curr Oncol Rep, 2002 Apr 09; 4(3). PMID: 11937018
Review.
Comparison of the oral (PABA) pancreatic function test, the secretin-pancreozymin test and endoscopic retrograde pancreatography in chronic alcohol induced pancreatitis.
A S Mee, A H Girdwood, +3 authors, I N Marks.
Gut, 1985 Nov 01; 26(11). PMID: 3877666    Free PMC article.
Case report: pancreatic cancer presenting with paraneoplastic gastroparesis.
S Caras, S Laurie, +3 authors, R W McCallum.
Am J Med Sci, 1996 Jul 01; 312(1). PMID: 8686728
The effects of moderate doses of megestrol acetate on nutritional status and body composition in a hemodialysis patient.
J D Burrowes, P A Bluestone, J Wang, R N Pierson.
J Ren Nutr, 1999 Mar 25; 9(2). PMID: 10089265
Simultaneous assessments of exocrine pancreatic function by cholesteryl-[14C]octanoate breath test and measurement of plasma p-aminobenzoic acid.
M J Bruno, F J Hoek, +4 authors, G N Tytgat.
Clin Chem, 1995 Apr 01; 41(4). PMID: 7720253
A noninvasive stable-isotope method to simultaneously assess pancreatic exocrine function and small bowel absorption.
J C Deutsch, C R Santhosh-Kumar, V R Kolli.
Am J Gastroenterol, 1995 Dec 01; 90(12). PMID: 8540512
Physiologic response to a protein, carbohydrate, fat meal in patients with human immunodeficiency virus who underwent small intestinal enteropathy as characterized by a kinetic model of D-xylose absorption.
S J Carlson, J C Deutsch, R M Craig.
JPEN J Parenter Enteral Nutr, 1998 Jan 23; 22(1). PMID: 9437651
Diagnosis of chronic pancreatitis using noninvasive tests of exocrine pancreatic function--comparison to duodenal intubation tests.
K Kataoka, Y Yamane, M Kato, K Kashima.
Pancreas, 1997 Nov 15; 15(4). PMID: 9361096
D-xylose testing: a review.
R M Craig, A J Atkinson.
Gastroenterology, 1988 Jul 01; 95(1). PMID: 3286361
Review.
Cytokine activity in cancer-related anorexia/cachexia: role of megestrol acetate and medroxyprogesterone acetate.
G Mantovani, A Macciò, +3 authors, M C Santona.
Semin Oncol, 1998 Jun 13; 25(2 Suppl 6). PMID: 9625383
Review.
Improved quality of life with megestrol acetate in patients with endocrine-insensitive advanced cancer: a randomised placebo-controlled trial. Australasian Megestrol Acetate Cooperative Study Group.
E Beller, M Tattersall, +11 authors, R J Simes.
Ann Oncol, 1997 Mar 01; 8(3). PMID: 9137798
Treatment of the cancer anorexia-cachexia syndrome: a critical reappraisal.
G Lelli, M Montanari, +3 authors, D Scapoli.
J Chemother, 2003 Jul 19; 15(3). PMID: 12868546
Review.
Exocrine pancreatic function following pancreatectomy.
P Ghaneh, J P Neoptolemos.
Ann N Y Acad Sci, 1999 Jul 23; 880. PMID: 10415875
Review.
Normal digestive physiology and the evaluation of digestive function.
J C Deutsch.
Semin Oncol, 1998 Jun 13; 25(2 Suppl 6). PMID: 9625377
Review.
Improvement in quality-of-life measures and stimulation of weight gain after treatment with megestrol acetate oral suspension in geriatric cachexia: results of a double-blind, placebo-controlled study.
S S Yeh, S Y Wu, +5 authors, M W Schuster.
J Am Geriatr Soc, 2000 May 16; 48(5). PMID: 10811540
Progestogens and Cushing's syndrome.
C Harte, M T Henry, K D Murphy, T H Mitchell.
Ir J Med Sci, 1995 Oct 01; 164(4). PMID: 8522428
Improved specificity of the PABA test with p-aminosalicylic acid (PAS).
F J Hoek, F A van den Bergh, +3 authors, G N Tytgat.
Gut, 1987 Apr 01; 28(4). PMID: 3495472    Free PMC article.
Placebo controlled trial of enteric coated pancreatin microsphere treatment in patients with unresectable cancer of the pancreatic head region.
M J Bruno, E B Haverkort, +2 authors, D J van Leeuwen.
Gut, 1998 Mar 20; 42(1). PMID: 9505892    Free PMC article.
Megestrol acetate in advanced, progressive, hormone-insensitive cancer. Effects on the quality of life: a placebo-controlled, randomised, multicentre trial.
G Westman, B Bergman, +13 authors, P Orgum.
Eur J Cancer, 1999 Sep 24; 35(4). PMID: 10492632
A pilot study of megestrol acetate and ibuprofen in the treatment of cachexia in gastrointestinal cancer patients.
D C McMillan, P O'Gorman, K C Fearon, C S McArdle.
Br J Cancer, 1997 Jan 01; 76(6). PMID: 9310247    Free PMC article.
Nutrient malassimilation following total gastrectomy.
R Brăgelmann, U Armbrecht, +3 authors, R W Stockbrügger.
Scand J Gastroenterol Suppl, 1996 Jan 01; 218. PMID: 8865447
Cytokine involvement in cancer anorexia/cachexia: role of megestrol acetate and medroxyprogesterone acetate on cytokine downregulation and improvement of clinical symptoms.
G Mantovani, A Macciò, +3 authors, M C Santona.
Crit Rev Oncog, 1999 Feb 11; 9(2). PMID: 9973244
Review.
Nutritional considerations after gastrectomy and esophagectomy for malignancy.
Amelia Baker, Leigh-Anne Wooten, Michele Malloy.
Curr Treat Options Oncol, 2011 Jan 26; 12(1). PMID: 21264689
Review.
Pancreatic cancer cachexia: a review of mechanisms and therapeutics.
Carlyn R Tan, Patrick M Yaffee, +5 authors, Andrew E Hendifar.
Front Physiol, 2014 Mar 14; 5. PMID: 24624094    Free PMC article.
Review.
Pancreatic Cancer Cachexia: The Role of Nutritional Interventions.
Toni Mitchell, Lewis Clarke, Alexandra Goldberg, Karen S Bishop.
Healthcare (Basel), 2019 Jul 22; 7(3). PMID: 31323984    Free PMC article.
Review.