Source: DGNews  |  Posted 2 years ago

By Ed Susman

ORLANDO, Fla -- January 25, 2010 -- Treatment with 3 drugs that impact side
effects of cancer treatment and the disease process appears to prevent profound
weight loss that often accompanies advanced gastrointestinal cancer,
researchers said here at the 2010 Gastrointestinal Cancers Symposium (ASCO-GI).

“We wanted to determine if combining thalidomide with olanzapine and megestrol
would attenuate weight loss in our patients,” said Suresh Sanchetee, MD,
Rajasthan Cancer Cure Hospital, Jodhpur, India, during his poster presentation
on January 23. “This combination was successful in preventing both weight loss
and lean muscle loss in these terminally ill patients.”

“About 90% of our patients with gastrointestinal cancers present to us in late
stage and palliation is our only option,” said Dr. Sanchetee.

In the study, 24 patients (13 men) were assigned to receive thalidomide 100
mg/day, known to inhibit certain cytokines involved in cancer cachexia. Another
group of 13 patients (12 men) were treated with thalidomide 100 mg/day plus
olanzapine 5 mg/day and megestrol acetate 80 mg/day for 24 weeks.

Dr. Sanchetee noted that olanzapine is effective in preventing
chemotherapy-induced nausea and vomiting and megestrol has proved useful in
preventing weight loss in patients with cancer.

After 8 weeks of treatment, patients treated with the combination therapy had
maintained their baseline weight and had an insignificant decrease in lean
muscle loss, measured by determining free arm muscle.

However, patients receiving thalidomide monotherapy had lost more than 3.5 kg
of weight (P = .034) and had lost more than 8 cm3 of
lean arm muscle (P = .014).

The patients were aged about 60 years and had already lost 10 kg of their
premorbid weight at the time they were entered into the trial, Dr. Sanchetee
said.

Dr. Sanchetee also attempted to determine if use of the treatment to control
weight loss had any impact on the patients’ quality of life. “We were unable to
demonstrate that we favourably impacted their life,” he said. “However, we
think it is difficult to have a positive effective on quality of life -- even
by maintaining their weight -- because of their advanced disease.”

On the other hand, he said the treatment appeared safe and effective in
maintaining weight. “It remains to be seen whether this treatment can be
generalised to all cancers,” Dr. Sanchetee said. He is continuing to follow the
patients to determine if the treatment improves survival.

The 2010 Gastrointestinal Cancers Symposium is sponsored by the American
Gastroenterological Association Institute, the American Society of Clinical
Oncology, the American Society for Therapeutic Radiation Oncology, and the
Society of Surgical Oncology.

[Presentation title: Thalidomide Versus Thalidomide With Olanzapine and Megestrol Acetate in Treatment of Cachexia in Gastrointestinal Cancer: A Randomized Trial. Abstract 209]