The effect of megestrol acetate on anorexia, weight loss and cachexia in cancer and AIDS patients (review).

Weight gain is a well-known side-effect of megestrol acetate (MA) treatment. This effect has been studied systematically in cancer and AIDS patients with involuntary weight loss, anorexia or manifest cachexia, situations in which weight gain is desirable. Significant, positive effects on weight gain and on certain quality of life aspects, such as appetite, nausea, body image and mood have been reported for cancer patients treated with 160 mg to 1.600 mg daily and similar effects have been registered in AIDS patients if doses of about 400-800 mg are used. Maximal weight gain is normally achieved within 8 weeks. The weight gain is, unfortunately, mainly due to an increase in fat mass and partly due to edema and, therefore, no significant effects are reported as regards the Karnovsky index. If anorexia, nausea and a negative body image are major concerns and if the patient has a life expectancy of more than 3 months, MA is a reasonable treatment option. However, if the central problem is fatigue and a low Karnovsky index, especially in a patient with a short expected survival, MA, which is not inexpensive, is not likely to be of significant help.