This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Jatoi, A. Articles by Dakhil, S. Search for Related Content PubMed Articles by Jatoi, A. Articles by Dakhil, S. Related Articles Related Correspondence Social Bookmarking                            What's this?

In Reply:

Department of Oncology, Mayo Clinic, Rochester, MN

Kendrith Rowland

Carle Cancer Center, Urbana, IL

Shaker Dakhil

Cancer Center of Kansas, Wichita, KS

We thank Drs Dahele and Wall for their comments and are pleased to respond.

The North Central Cancer Treatment Group (NCCTG) recently reported a three-arm trial that compared a fish oil–derived eicosapentaenoic acid (EPA) nutritional supplement with megesterol acetate.¹ This 421-patient trial concluded that EPA adds little to current treatments of the cancer anorexia/weight-loss syndrome.

We share the disappointment of Drs Dahele and Wall. We, too, had hoped that EPA would help patients with cancer. This disappointment should not, however, detract from the inevitable conclusion of this large comparative trial and of the two others that preceded it^2,3: EPA did not work. It did not fulfill the promise generated by earlier pilot studies.

There is a dearth of phase III data that support the use of EPA in the treatment of the cancer anorexia/weight-loss syndrome. Drs Dahele and Wall provide insight into some of the challenges of research on the cancer anorexia/weight-loss syndrome by commenting on the importance of clinically relevant end points, the need for compliance assessment, and the potential of early intervention. These are important points, and we acknowledge that each of these three "negative" trials may have limitations. However, any such limitations in their own right do not justify the use of EPA.

After three large "negative" studies, the onus of demonstrating benefit now rests in the hands of proponents of EPA. These proponents must put forth critical new evidence to convince cancer patients, their families, and oncologists that this agent continues to be worthy of clinical investigation. For others of us who continue to observe the devastating decline of weight-losing cancer patients on a daily basis—despite their ingestion of EPA-containing supplements—we think it time to move on and study other agents.

Authors' Disclosures of Potential Conflicts of Interest

The authors indicated no potential conflicts of interest.

Acknowledgment

The authors whish to acknowledge Dr Gabriel N. Hortobagyi for reviewing this letter.

REFERENCES

1. Jatoi A, Rowland K, Loprinzi CL, et al: An eicosapentaenoic acid supplement versus megestrol acetate versus both for patients with cancer-associated wasting: A North Central Cancer Treatment Group and National Cancer Institute of Canada collaborative effort. J Clin Oncol 22:2469-2476, 2004[Abstract/Free Full Text]

2. Bruera E, Strasser F, Palmer JL, et al: Effect of fish oil on appetite and other symptoms in patients with advanced cancer and anorexia/cachexia: A double-blind, placebo-controlled study. J Clin Oncol 21:129-134, 2003[Abstract/Free Full Text]

3. Fearon KC, Von Meyenfeldt MF, Moses AG, et al: Effect of a protein and energy dense N-3 fatty acid enriched oral supplement on loss of weight and lean tissue in cancer cachexia: A randomised double blind trial. Gut 52:1479-1486, 2003[Abstract/Free Full Text]

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Correspondence

• Optimizing End Points and Outcomes in Cancer-Associated Wasting
  M. Dahele and L. Wall
  JCO 2005 23: 2871-2872 [Full Text]

This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Jatoi, A. Articles by Dakhil, S. Search for Related Content PubMed Articles by Jatoi, A. Articles by Dakhil, S. Related Articles Related Correspondence Social Bookmarking                            What's this?