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Dronabinol Versus Megestrol Acetate Versus Combination Therapy for Cancer-Associated Anorexia: A North Central Cancer Treatment Group Study

From the Mayo Clinic and Mayo Foundation, Rochester; CentraCare Clinic, St Cloud; and Duluth Community Clinical Oncology Program, Duluth, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Missouri Valley Consortium, Omah, NE; Carle Cancer Center Community Clinical Oncology Program, Urbana, IL; Ochsner Community Clinical Oncology Program, New Orleans, LA; and Scottsdale Community Clinical Oncology Program, Scottsdale, AZ.

Address reprint requests to Aminah Jatoi, MD, Mayo Clinic, 200 1st St, SW, Rochester, MN 55905; email: jatoi.aminah{at}mayo.edu

PURPOSE: To determine whether dronabinol administered alone or with megestrol acetate was more, less, or equal in efficacy to single-agent megestrol acetate for palliating cancer-associated anorexia.

PATIENTS AND METHODS: Four hundred sixty-nine assessable advanced cancer patients were randomized to (1) oral megestrol acetate 800 mg/d liquid suspension plus placebo, (2) oral dronabinol 2.5 mg twice a day plus placebo, or (3) both agents. Eligible patients acknowledged that loss of appetite or weight was a problem and reported the loss of 5 pounds or more during 2 months and/or a daily intake of less than 20 calories/kg of body weight.

RESULTS: Groups were comparable at baseline in age, sex, tumor type, weight loss, and performance status. A greater percentage of megestrol acetate-treated patients reported appetite improvement and weight gain compared with dronabinol-treated patients: 75% versus 49% (P = .0001) for appetite and 11% versus 3% (P = .02) for 10% baseline weight gain. Combination treatment resulted in no significant differences in appetite or weight compared with megestrol acetate alone. The Functional Assessment of Anorexia/Cachexia Therapy questionnaire, which emphasizes anorexia-related questions, demonstrated an improvement in quality of life (QOL) among megestrol acetate–treated and combination-treated patients. The single-item Uniscale, a global QOL instrument, found comparable scores. Toxicity was also comparable, with the exception of an increased incidence of impotence among men who received megestrol acetate.

CONCLUSION: In the doses and schedules we studied, megestrol acetate provided superior anorexia palliation among advanced cancer patients compared with dronabinol alone. Combination therapy did not appear to confer additional benefit.

This study was conducted as a collaborative trial of the North Central Cancer Treatment Group and the Mayo Clinic.

Dronabinol was provided by Roxane Laboratories, Columbus, OH; megestrol acetate was provided by Bristol-Myers Squibb, Princeton, NJ.

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