Progestins are synthetic hormones that have activity that simulates progesterone, the female hormone that is elevated during pregnancy. Progestin is a type of steroid structure and is the main component of birth control medications. Progestins have been evaluated for effect in patients with cancer for anorexia, chemotherapy-induced nausea and vomiting (CINV), hot flashes, and fatigue.
Likely to Be Effective
Research Evidence Summaries
Zang, J., Hou, M., Gou, H.F., Qiu, M., Wang, J., Zhou, X.J., … Yi, C. (2011). Antiemetic activity of megestrol acetate in patients receiving chemotherapy. Supportive Care in Cancer, 19, 667–673.doi: 10.1007/s00520-010-0886-x
To evaluate the antiemetic properties of megestrol acetate (MA) in patients receiving moderately emetogenic chemotherapy (MEC) or highly emetogenic chemotherapy (HEC)
Intervention Characteristics/Basic Study Process:
Patients were randomly assigned to receive either MA or placebo combined with routine antiemetic medications during the first cycle of chemotherapy and used the alternative during the second cycle. Patients were given oral MA or a placebo tablet prior to the start of chemotherapy then daily on days 1–4 of the chemotherapy. All patients were given granisetron and metoclopramide daily on days 1–4 of chemotherapy. Patients received either MEC or HEC for one day. Patients recorded nausea, vomiting, and adverse experiences daily on diary cards during days 1–5 of chemotherapy.
- The sample consisted of 100 patients.
- Mean age was 51.6 years (SD = 10 years).
- The sample was 39% female and 61% male.
- Cancer diagnoses were 67% alimentary tract cancer (including esophageal cancer, gastric cancer, colorectal cancer) and 33% lung cancer.
- Slightly more than half (56%) of patients received HEC, and 44% received MEC.
- Patients were not eligible for the study if they experienced nausea or vomiting before the start of chemotherapy or if they used antiemetic agents within 72 hours of the study.
The study was conducted at a single cancer center in China.
Phase of Care and Clinical Applications:
All patients were in active treatment.
This was a randomized, single-blind, placebo-controlled, crossover study.
Patients recorded each emetic episode, their assessment of nausea and global satisfaction, and occurrence of any adverse effects on diary cards.
- MA combined with granisetron and metoclopramide provided higher protection of chemotherapy-induced nausea and vomiting (CINV) (p = 0.000) than no MA.
- HEC patients who received MA had less CINV in comparison to patients with no MA (p = 0.001).
- MEC patients who received MA had less CINV than patients with no MA (p = 0.002).
- In the acute phase, nausea was higher (p = 0.039) and vomiting was more frequent (p = 0.003) without MA than with MA.
- In the delayed phase, nausea (p = 0.000) and vomiting (p = 0.000) were lower with MA than without.
- All adverse events were mild and did not cause patients to discontinue the drug.
MA provides higher rates of CINV protection in the acute and delayed phase of chemotherapy, especially the delayed phase. MA is effective in patients receiving HEC and MEC.
- This was a single institution study.
- Demographic characteristics were not reported between the two different groups of subjects (MA versus placebo); therefore, it is unclear if characteristic differences may have influenced outcomes.
MA may have some antiemetic activity in patients receiving moderate to highly emetic chemotherapy and should be considered as part of an antiemetic regimen.