Table 1. Summary of recommendations for the treatment of
cancer cachexia in patients with advanced cancer
(cont'd)
Intervention
Strength of
recommendation
Strength of
the evidence Benefits
a
Harms
a
Melatonin Weak against Low None Low
TNF inhibitors Moderate against Intermediate None Moderate
Hydrazine sulfate Strong against Intermediate None Moderate
Other Interventions
Exercise No
recommendation
Low Unknown Unknown
a
Categorization of benefits and harms was based on use of the intervention for cancer cachexia in the
populations that were enrolled in RCTs.
Table 2. Pharmaceutical options for management of cancer
cachexia
Agent
Suggested
dosing Benefits Risks
Cost per
month
a
Megestrol acetate/
medroxyprogesterone
200–600 mg/day;
liquid formulation
may be less
expensive and
more bioavailable
than tablets
Improved
appetite,
weight gain
Edema,
romboembolism,
Adrenal
insufficiency
$57.41
b
Corticosteroids 3–4 mg
dexamethasone
equivalent dose/
day
c
Improved
appetite
Multiple common
toxicities
$27.11
a
Prices for orally administered drugs reimbursed through Medicare Part D were identified in the
PlanFinder for a beneficiary living within ZIP code 10065 (www.medicare.gov). We selected a Humana
PDP plan with the lowest cost for beneficiaries to identify the full cost of each drug. Drug costs may
vary by plan and by pharmacy where a prescription is filled (eg, preferred or nonpreferred pharmacies).
Note: drug prices are dynamic and the prices listed in the table may not reflect current prices.
b
Cost is for megestrol acetate, 400 mg/day, given as 40 mg/ml suspension in 10 ml cups
c
e original dose evaluated was 0.75 mg four times daily. However, given the long biological half-life,
once daily dosing is recommended.
