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Released 5/12/2001
Loss of appetite and weight is a major problem, affecting more than half of patients with advanced cancer. This first of its kind study, titled Dronabinol Versus Megestrol Acetate Versus Combination Therapy For Cancer-Associated Anorexia, found megestrol acetate was superior to dronabinol for improving appetite and boosting weight gain. It also found that when both drugs were given together, dronabinol added no notable benefit over and above that provided by megestrol acetate alone.
The study was conducted by NCCTG, an affiliation of 23 community clinics and affiliates in 18 states and two Canadian provinces with a research base at Mayo Clinic Cancer Center in Rochester. Dr. Aminah Jatoi (ja 'toy), a Mayo Clinic medical oncologist and lead researcher on the study, presented the results at the annual meeting of the American Society of Clinical Oncology (ASCO) in San Francisco.
“Anecdotal reports and previous small studies suggest marijuana derivatives stimulate appetite, but in our study we found the drug dronabinol, in the doses prescribed in this trial, doesn’t hold up to standard treatment with megestrol acetate,” says Dr. Jatoi.
“We found that megestrol acetate is superior to dronabinol in the treatment of cancer-associated loss of appetite and we found the addition of dronabinol to megestrol acetate does not provide additional benefit,” she said.
“Seventy-five percent of patients taking megestrol acetate reported appetite improvement compared with only 49 percent taking dronabinol. Further, 11 percent of the patients on megestrol acetate versus 3 percent on dronabinol regained more than 10 percent of their baseline weight.”
According to Dr. Jatoi, loss of appetite and weight is a common but understudied problem among cancer patients.
“Nobody knows all of the factors that come into play as cancer patients lose weight,” she said. “This study was an attempt to help cancer patients by finding some answers about what works and what doesn’t for those struggling with eating. To our knowledge, this is the first study to compare a standard drug to a drug derived from marijuana in an effort to help patients with this problem.”
The study evaluated 469 patients between December 1996 and December 1999. Patients were age 18 years or older, and all had been diagnosed with an advanced cancer, other than brain, breast, ovarian or endometrial cancer.
The patients had an estimated life expectancy of greater than three months. They also had to have a self-reported loss of appetite and/or weight loss of at least five pounds during the preceding two months.
The double-blinded study randomly enrolled the patients into one of three treatment sections:
1) megestrol acetate liquid given 800 mg orally each day plus capsule placebos
2) 2.5 mg dronabinol capsules given orally twice a day plus liquid placebo
3) a combination of both medications in the dosages noted
“Megestrol acetate is not the complete answer to stimulating appetite and boosting weight in cancer patients,” says Dr. Jatoi. “More research needs to be done to find better drugs, but at this time we know that megestrol acetate is more effective than dronabinol in the doses we tested.
“Our findings, that dronabinol does little to promote appetite or weight gain among advanced cancer patients compared to megestrol acetate, should dampen enthusiasm for using marijuana derivatives for this purpose,” she said.
The North Central Cancer Treatment Group (NCCTG) clinics participating with Mayo Clinic in Rochester to conduct the study included CentraCare Clinic in St. Cloud, MN; Wichita Community Clinical Oncology Program in Wichita, KS; Missouri Valley Consortium in Omaha, NE; Carle Cancer Center in Urbana, IL; Oschner Clinic in New Orleans, LA; Duluth Clinic in Duluth, MN; and Mayo Clinic in Scottsdale, AZ.
Contact Information:
Mary Lawson
507-266-0810 (days)
e-mail: newsbureau@mayo.edu
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