ISSN:0030-2414    

DOI:10.1159/000227117

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Nutritional assessments of our patients with disseminated malignancies have revealed that the incidences of reported anorexia, decreased food intake, and weight loss range between 49 and 64%. It is therefore essential that a planned approach to the nutritional needs of patients with advanced cancer be part of routine oncology care. Our first step is a clinical assessment of the patient’s nutritional state and diet, and a determination of caloric and nutrient needs. The potential tools available to the oncologist in the management of the undernourished cancer patient are many and include dietary counseling, food supplements (which contain vitamins and other micronutrients), stimulation of appetite, enteral nutrition, total parenteral nutrition, or a combination of these. The dietitian can be an invaluable component of the cancer care team, both in the inpatient and outpatient settings. An understanding of the role of each intervention will enable the physician to use available resources rationally and efficientl

ISSN:0030-2414    

DOI:10.1159/000227118

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

High-dose megestrol acetate (800 mg/day) was administered to 34 patients as third-line endocrine therapy for metastatic breast cancer after progression on standard-dose megestrol acetate (160 mg/day). Among the 32 evaluable patients, no complete or partial response occurred. Ten patients remained stable and 22 progressed. No patients remained on study. Median time to progression was 2 months (range, 1-13 months). The use of high-dose megestrol acetate did not result in objective responses but may have been effective in delaying progression in one third of patients.

ISSN:0030-2414    

DOI:10.1159/000227119

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Empiric clinical trials have revealed new mechanisms by which hormonal therapies may exert their antitumor effects. Initial studies using escalated doses of agents like toremifene and megestrol acetate have yielded interesting results, showing responses in hormone-receptor-negative patients and in patients progressing after standard doses, respectively. A trial by Cancer and Leukemia Group B randomizing patients with advanced breast cancer to standard-dose (160 mg) megestrol acetate or to 5 or 10 times the standard dose (800 and 1,600 mg) has completed accrual. It is hoped that these results will provide a definitive answer to the dose-response issue for breast cancer. However, regardless of this trial’s ultimate outcome, higher doses of megestrol acetate have demonstrated important new effects on appetite stimulation and weight gain; ongoing laboratory research promises potential roles for megestrol acetate in the reversal of chemotherapeutic drug-induced tumor resistanc

ISSN:0030-2414    

DOI:10.1159/000227121

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The response of breast cancer to endocrine therapy depends on depriving the tumor cells of estrogen stimulation of cell division. This may be achieved by blocking estrogen synthesis in the body, using inhibitors of aromatase or by using drugs like tamoxifen, which interfere with the direct effects of estrogen on tumor cells. Current controversies relate to the mechanism for achieving more effective inhibition of estrogen synthesis and for the use of more specific antiestrogenic drugs.

ISSN:0030-2414    

DOI:10.1159/000227122

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Although current hormonal therapy of prostate cancer may not appear to have altered survival appreciably, there have been considerable changes that may significantly affect the future management of this disease. A number of new hormonal agents have been introduced that still require definition of their therapeutic efficacy. Megestrol acetate, a hormonal agent with multiple sites of action in androgen metabolism, has recently been investigated in the treatment of patients with metastatic and locally advanced disease, and in those patients whose disease progresses with other hormonal therapies. Megestrol acetate plus mini-dose diethylstilbestrol (DES) is associated with fewer side effects than standard-dose DES and has equivalent therapeutic efficacy in the treatment of patients with metastatic disease. In patients with locally advanced disease that may benefit from hormonal cytoreduction, megestrol acetate is effective and well tolerated. Megestrol acetate has a role in the palliation of patients with progressive disease despite initial hormonal therapy. Considerable controvery surrounds the therapy of carcinoma of the prostate; further studies are required to define optimal hormonal therapy.

ISSN:0030-2414    

DOI:10.1159/000227123

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Despite the development of advanced nutritional support technology, malnutrition remains a significant morbid and mortal complication of cancer. A number of metabolic abnormalities have been demonstrated in malnourished cancer patients, including increased protein breakdown, increased glucose production, increased lipolysis, hypogonadism in male patients, and insulin resistance. Previous studies conducted under metabolic ward conditions have demonstrated that metabolic abnormalities interfere with efforts at renutrition of patients with localized head and neck cancer. Efforts to correct these abnormalities by treatment with hydrazine sulfate, anabolic androgens, and insulinotropic drugs have been ineffective. An improved understanding of the pathophysiology of cancer malnutrition may lead to improved therapies of this vexing clinical problem.

ISSN:0030-2414    

DOI:10.1159/000227124

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Megestrol acetate, a semisynthetic gestagen, is effective not only for endocrine therapy of advanced breast carcinomas, but also in the treatment of cachectic patients with aggressive, hormone-independent tumors. Sixty-six patients with therapy-resistant, advanced bronchogenic carcinomas of different histologic types, who had lost more than 10% of their regular body weight within a prospective, randomized trial, were treated with megestrol acetate at a dose of either 160 or 480 mg/day for 3-4 months. The mean weight gain for all patients was 2.5 kg. Nearly all of them (80%) reported improved appetite and well-being. The mean weight gain in the group of patients receiving 480 mg/day was higher (3.0 kg) than in the group receiving 160 mg/day (2.0 kg).

ISSN:0030-2414    

DOI:10.1159/000227125

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Cachexia occurs in the majority of cancer patients before death. It is the result of major metabolic changes produced by tumor-released substances as well as by cytokines and some endogenous peptides. The most significant clinical manifestation is profound anorexia. Aggressive parenteral nutrition has not been able to increase patient survival or produce any significant symptomatic improvement. Recent research, therefore, has focused on drugs that might result in symptomatic improvement, even if no significant nutritional changes are detected. Corticosteroids have been shown to increase appetite for a brief period of time, but they do not appear to improve caloric intake or nutritional status. In addition to appetite stimulation, corticosteroids also improve a number of other symptoms transiently. Progestational drugs have been found in a number of studies to increase appetite, caloric intake, and nutritional status. The most effective type and dose of progestational drugs have not been clearly established. Cyproheptadine, hydrazine sulfate, and cannabinoids have all been suggested to have beneficial effects on appetite; their effectiveness, however, needs to be confirmed in prospective, controlled trials. Some of these trials are currently under way. Current data suggest that megestrol acetate or other progestational agents could be useful – because of effects on not only appetite but also overall nutritional status – in patients who have profound anorexia as the main manifestation of cachexia, provided expected survival can be measured in weeks or months. In patients with shorter expected survival or those who have problems tolerating progestational drugs, a brief course of corticosteroids may provide short-term symptomatic effects. Future studies should focus on (1) improving understanding of both the pathophysiology of cancer cachexia and the interaction of some of the major syndromes of terminal cancer – e.g., pain, cachexia, and cognitive failure – and (2) characterizing the symptomatic effects of different drugs more com

ISSN:0030-2414    

DOI:10.1159/000227126

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

A placebo-controlled, randomized trial assessed the activity, tolerance, and degree of weight gain and anorexia of two doses of megestrol acetate in patients with advanced cancer and cachexia. Patients received either low-dose (480 mg/day) or high-dose (960 mg/day) megestrol acetate or placebo for 8 weeks. As of March 1991, 91 patients had been randomized; 65 patients were evaluable. Median initial weight loss in all patients ranged from 13 to 16%. Further weight loss was seen in 13 of 17 patients in the placebo group, compared with 10 of 27 and 6 of 21 in the low- and high-dose megestrol acetate groups, respectively. Eight of 27 patients in the low-dose-group and 9 of 21 in the high-dose group gained weight, with a median of 3 and 4 kg, respectively. Beneficial effects of megestrol acetate were seen in 63 and 71 % of the low- and high-dose groups, respectively, compared with 24% of the placebo group. Side effects of megestrol acetate were mild. No correlation between megestrol acetate dosage and weight gain was found, but there was a tendency for increased weight in more patients taking high-dose megestrol acetate.

ISSN:0030-2414    

DOI:10.1159/000227127

出版商:S. Karger AG    

年代:1992

数据来源: Karger