Clinical studies on the treatment of cancer cachexia with megestrol acetate plus thalidomide.

BACKGROUND: The management of cancer-related anorexia/cachexia syndrome (CACS) is a great challenge in clinical practice. To date, practice guidelines for the prevention and treatment of CACS are lacking. The authors conducted a randomized study to confirm the effectiveness and safety of treatment of CACS utilizing megestrol acetate (MA) plus thalidomide. METHODS: One hundred and two candidates with CACS were randomly assigned to two treatment groups (trial group and control group): the trial group received MA (160 mg po, bid) plus thalidomide (50 mg po, bid), while the control group received MA (160 mg po, bid) alone. Treatment duration was 8 weeks. RESULTS: Analysis of the trial group demonstrated a significant increase from baseline in body weight (<0.01), quality of life (p = 0.02), appetite (p = 0.01), and grip strength (p = 0.01), and a significant decrease in fatigue, Glasgow Prognostic Score (p = 0.05), Eastern Cooperative Oncology Group performance status (p = 0.03), IL-6 (p < 0.01), and tumor necrosis factor-α (p = 0.02). In contrast, in the control group, endpoints with a significant improvement from baseline included body weight (p < 0.02) and appetite (p = 0.02). The mean changes in the endpoints from baseline in the trial group were significantly greater compared with the control group: in the primary endpoints, body weight (p = 0.05), fatigue (p < 0.01) and quality of life (p = 0.01), and in the secondary endpoints, grip strength (p = 0.05), Glasgow Prognostic Score (p = 0.02), Eastern Cooperative Oncology Group performance status (p = 0.02), IL-6 (p < 0.01) and tumor necrosis factor-α (p = 0.01). Toxicity was found to be relatively negligible in both groups. CONCLUSION: A combination regimen of MA and thalidomide is more effective than MA alone in the treatment of CACS.

[Analysis of mortal risk factors in 12 patients with severe acute respiratory syndrome].

OBJECTIVE: To investigate the risk factors in the dead patients with severe acute respiratory syndrome (SARS). METHODS: The retrospective analyses were made on 12 dead cases and 32 recovered cases with SARS. RESULTS: The mean age was 67 years old in 12 dead cases with SARS and was 42 in recovered control group. There were 1-5 other basic diseases in 5 cases of death group. The states of dead patients were severe and the deterioration of patients' condition was rapid. The CD 4 and CD 8 T lymphocytes in peripheral blood were (416.6+/-235.0) cells/microl and (296.1+/-181.5)cells/microl in survival patients and (143.8+/-78.1)cells/microl, (103.6+/-63.2) cells/microl in dead patients, they often decreased compared to the normal values, especially in dead cases. Five cases were infected with bacteria in 12 dead cases, among them 3 were infected with fungus and 2 were septicemia. In dead group, the occurrence rates of electrolyte maladjustment and kidney injury were 41.67 percent. Invasive ventilation was used in 10 cases and death rate was 80.0 percent, among them 5 patients were infected with bacteria. None was dead in the patients with non-invasive ventilation. CONCLUSION: The age and basic diseases are the main mortal risk factors in SARS. Other risk factors include the decline of immune function, secondary infection, complications and use of invasive ventilation.