Maltoni, M., Nanni, O., Scarpi, E., Rossi, D., Serra, P., & Amadori, D. (2001). High-dose progestins for the treatment of cancer anorexia-cachexia syndrome: A systematic review of randomised clinical trials. Annals of Oncology, 12, 289–300.

To review the prospective randomized clinical trials (RCTs) that evaluate the use of progestins in cancer anorexia-cachexia syndrome compared with placebo in patients with hormone-independent tumors

Databases searched were MEDLINE, CANCERLIT, Embase, and CINAHL, in addition to hand searching of reference lists.

Of the 38 studies identified, 15 RCTs, published between July 1990 and June 1999, met inclusion criteria. The studies selected used various drug dosages, durations of treatment, eligibility criteria, population types, study designs, methods of assessment, methods of reporting results, and outcomes.

The review reported on 2,102 patients, compiled from six studies of 557 patients that received neither chemotherapy nor radiation, and nine studies of 1,545 patients that received some form of concomitant therapy.

Among the several outcomes analyzed, effect on body weight was assessed in all studies, and only two studies did not evaluate the effect on appetite. The most frequent method of assessing appetite was the visual analog scale.

There was a significant advantage for the use of high-dose progestins regarding improved appetite and body weight gain to support the safety and feasibility of treatment with oral progestins.

Most of the studies were short in duration, lasting from 1 to 12 weeks.

Important issues, such as dosage, duration of treatment, best time to start treatment, and eventual impact on overall improved quality of life, have yet to be defined.