Radiation Oncology/Cachexia

Treatment
These medications treat the loss of appetite and weight loss but do not treat the cachexia itself.

Medications:
 * Corticosteroids:
 * Stimulate appetite, but effect lasts only for 4-8 weeks, and does not lead to weight gain.
 * Dronabinol (Marinol)
 * Stimulates appetite but does not clearly lead to weight gain
 * Megestrol (Megace)
 * Most potent
 * Anabolic steroids: nandrolone, fluoxymesterone, oxandrolone (increases lean tissue mass)

Nutritional supplements:
 * Boost, Ensure, etc.
 * Boost (Website) - 240 Cal per 8 oz can. Boost Breeze - 160 Cal (8 oz).
 * Boost Plus - 360 Cal (8 oz)
 * Boost High Protein - 240 Cal (8 oz), 15 g protein
 * Ensure (Website) - 250 Cal (8 oz).
 * Ensure Plus - 350 Cal (8 oz)
 * Ensure High Protein - 230 Cal (8 oz)
 * ProSure - Website
 * eicosapentaenoic acid (an omega-3 fatty acid) + protein + calories.
 * Provides 300 Cals (17 g protein) per can.
 * Use 2 cans per day.
 * Does not require prescription.
 * Juven - Website
 * HMB (beta-hydroxy-beta-methylbutyrate), arginine and glutamine.
 * Use: 2 servings per day (one packet per serving). Provides 150 Cal/day (75 Cal/pkg).
 * Does not require prescription

Exercise:
 * Weight training

Studies
Randomized:

Corticosteroids vs Megesterol
 * Mayo, 1999 (1992-96) - PMID 10506633 &mdash; "Randomized comparison of megestrol acetate versus dexamethasone versus fluoxymesterone for the treatment of cancer anorexia/cachexia." Loprinzi CL et al. J Clin Oncol. 1999 Oct;17(10):3299-306.
 * 475 pts. Similar efficacy for decadron (0.75 mg qid) and megace (800 mg qd = 5x160), but differing toxicities.