Agteresch, H. J., Dagnelie, P. C., van der Gaast, A., Stijnen, T., & Wilson, J. H. (2000). Randomized clinical trial of adenosine 5’-triphosphate in patients with advanced non-small-cell lung cancer. Journal of the National Cancer Institute, 92, 321–328.

A 30-hour infusion of adenosine 5’-triphosphate (ATP) was given every two to four weeks for 10 to 20 μg/kg/minute escalated to 75 μg/kg/minute. Regulation of biologic processes may be altered by ATP infusion to inhibit weight loss and deterioration of quality of life.

• The sample included 58 patients (ATP, n = 28; control, n = 30).
• Age and other parameters were similar.

• Outpatient
• The Netherlands

• Patients were randomized to ATP versus supportive care.
• Patients were stratified by tumor stage (IIIB or IV), prior chemotherapy versus none, and Karnofsky Performance Status (KPS) greater than 70 versus less than 70.

• Rotterdam Symptom checklist (RSCL)
• Single-item measures of tiredness and lack of energy

• A significant benefit of ATP was observed on tiredness (p = 0.0001) and lack of energy (p = 0.001).
• Mild, transient side effects were noted in the majority of patients.

• No placebo was administered, and outcome assessors were not blinded to patients' treatment arms.
• A control for concomitant steroids, which were given for brain edema, nausea, and dyspnea, did not exist.
• Ethical concerns arose about giving 10 30-hour infusions every two to four weeks (requiring hospital admissions) in patients with non-small cell lung cancer with limited expected lifespans.
• Hospitalization costs were a limitation.