Megestrol acetate in the management of cancer cachexia: a prospective quasi-experimental study focusing on body composition and patient-reported outcomes.

BACKGROUND

The objective of this study is to investigate the efficacy of megestrol acetate (MA) in treating cancer cachexia from multiple dimensions.

METHODS

In this prospective, non-randomized study, 97 patients with cancer cachexia were allocated to either a control group (n = 33, regular diet) or an MA group (n = 64, regular diet plus MA 320 mg/day) for 2 months. The primary endpoints were nutritional indices, including weight, BMI, total skeletal muscle mass, and fat mass. Secondary endpoints included inflammatory markers (CRP, IL-6, TNF-α), immune parameters (CD4+, CD8+ T cells), cancer-related fatigue (assessed by the Cancer Fatigue Scale), and quality of life (QOL).

RESULTS

Compared to baseline, the MA group exhibited significant improvements in body weight, BMI, fat mass, prealbumin (PA), albumin (ALB), and hemoglobin (Hb), coupled with a significant reduction in IL-6 levels and all domains of cancer-related fatigue (somatic, cognitive, affective, and total). Between-group analyses demonstrated that the MA group achieved significantly greater improvements in weight, BMI, fat mass, PA, ALB, and Hb. Skeletal muscle mass was maintained in the MA group, whereas the control group experienced a significant loss, resulting in a significant between-group difference. Furthermore, the MA group showed markedly greater reductions in all fatigue domain scores and a more substantial improvement in QOL. No significant between-group differences were observed for most inflammatory or immune markers. The intervention was well-tolerated with no reported drug-related adverse events.

CONCLUSION

MA significantly improves nutritional status and ameliorates cancer-related fatigue, thereby enhancing the quality of life in patients with cancer cachexia. Our findings provide robust evidence supporting the multi-dimensional benefits of MA in cachexia management, extending beyond mere weight gain to include muscle mass preservation and patient-centered symptom relief.