Megestrol More Effective than Dronabinol for Improving Appetite and Weight in Patients with Advanced Cancer

February 08, 2002

NEW YORK (MedscapeWire) Jan 30 - A drug derived from marijuana is not as effective as a standard drug for curbing loss of appetite and weight in patients with advanced cancer, according to a study conducted by Mayo Clinic in Rochester, Minnesota, and the North Central Cancer Treatment Group (NCCTG). The results of the study are published in the January issue of the Journal of Clinical Oncology.

This first-of-its-kind, double-blinded, multicenter study found megestrol acetate, a standard drug for treating loss of appetite and weight in cancer patients, to be more effective than dronabinol (brand name Marinol), a drug derived from marijuana. The study also found that there was no notable benefit when both drugs were given together.

"Anecdotal reports and previous small studies suggested that marijuana and its derivatives stimulate appetite," says Aminah Jatoi, MD, a Mayo Clinic oncologist and researcher on the study. "Our study found that dronabinol, in the doses prescribed in this trial, doesn't hold up to standard treatment with megestrol acetate."

"These findings should dampen enthusiasm for using marijuana derivatives for this purpose," Dr. Jatoi added.

Seventy-five percent of the patients taking megestrol acetate reported appetite improvement compared with 49% of patients taking dronabinol. Further, 11% of the patients on megestrol acetate, compared with 3% on dronabinol, gained more than 10% of their baseline weight.

Loss of appetite and weight is a major problem, affecting more than half of patients with advanced cancer. It's also an understudied problem.

"Nobody knows all of the factors that come into play as cancer patients lose weight," says Dr. Jatoi. "This study was an attempt to help cancer patients by finding some answers about what works and what doesn't work for those struggling with eating.

"To our knowledge, this is the first study to compare a standard drug to a drug derived from marijuana in an effort to help cancer patients with this problem," she said.

The study evaluated 469 cancer patients between December 1996 and December 1999. These patients were 18 years of age or older and all had been diagnosed with an advanced cancer. They also had to have a self-reported loss of appetite and/or weight loss of at least 5 pounds during the preceding 2 months.

The study randomly enrolled the patients into 1 of 3 treatment sections:

  • megestrol acetate liquid given 800 mg orally daily plus capsule placebo

  • dronabinol capsules given 2.5 mg orally twice a day plus liquid placebo

  • a combination of both medications in the dosages noted

Dr. Jatoi noted that megestrol acetate is not the complete answer to stimulating appetite and boosting weight in cancer patients, and more research needs to be done to find better drugs. "But at this time, we can say that megestrol acetate is more effective than dronabinol in the doses we tested," she said.

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