Conflict of Interest: Nothing to declare.
A randomized, double-blind, placebo-controlled clinical trial of megestrol acetate as an appetite stimulant in children with weight loss due to cancer and/or cancer therapy
Article first published online: 26 OCT 2013
© 2013 Wiley Periodicals, Inc.
Pediatric Blood & Cancer
Volume 61, Issue 4, pages 672–679, April 2014
How to Cite
Cuvelier, G. D.E., Baker, T. J., Peddie, E. F., Casey, L. M., Lambert, P. J., Distefano, D. S., Wardle, M. G., Mychajlunow, B. A., Romanick, M. A., Dix, D. B. and Wilson, B. A. (2014), A randomized, double-blind, placebo-controlled clinical trial of megestrol acetate as an appetite stimulant in children with weight loss due to cancer and/or cancer therapy. Pediatr. Blood Cancer, 61: 672–679. doi: 10.1002/pbc.24828
- Issue published online: 6 FEB 2014
- Article first published online: 26 OCT 2013
- Manuscript Accepted: 25 SEP 2013
- Manuscript Received: 19 JUN 2013
- May McLeod Northern Alberta Childhood Cancer Research Fund
- UBC Division of Pediatric Hematology-Oncology-BMT Research Fund
- appetite stimulant;
- megestrol acetate;
- pediatric cancer;
- randomized trial;
- weight loss
Megestrol acetate (MA) is an appetite stimulant with efficacy in promoting weight gain in adults with cancer-associated anorexia–cachexia. Studies documenting MA efficacy in children, however, are limited. We present the first randomized, double-blind, placebo-controlled clinical trial of MA versus placebo in children with cancer and weight loss.
Subjects <18 years of age with weight loss (minimum 5% from highest previous weight; or %ideal body weight <90%) due to cancer and/or cancer therapy were randomized to either MA (7.5 mg/kg/day) or placebo for a planned study duration of 90 days. Primary outcome was the difference between groups in mean percent weight change from beginning to end of the study period. Secondary outcomes included effects on anthropometrics, body composition, need for tube feeding or parenteral nutrition, and toxicities.
Twenty-six patients were randomly assigned (13 MA, 13 placebo). The MA group experienced a mean weight gain of +19.7% compared to a mean weight loss of −1.2% in the placebo group, for a difference of +20.9% (95%CI: +11.3% to +30.5%, P = 0.003) in favor of MA over placebo. MA subjects experienced significant increases in weight for age z-scores, body mass index z-scores, and mid upper arm circumference compared to placebo. DXA scanning suggested disproportionate increases in fat accrual. Adrenal suppression was the main toxicity of MA.
In children with high-risk malignancies, MA resulted in significant increases in mean percent weight change compared to placebo. Further studies of MA should be pursued to better delineate the effect on nutritional status. Pediatr Blood Cancer 2014;61:672–679. © 2013 Wiley Periodicals, Inc.