甲地孕酮治療cacs

1、,甲地孕酮治療癌癥相關的厭食性惡病質綜合征(CACS),腫瘤專業(yè)：段繼洪,,,病例資料,一、選題背景,,,,,患者，女，55歲，因“子宮內膜樣腺癌術后1年，持續(xù)腹痛3天”入院?；颊呷朐汉笸晟葡嚓P檢查，考慮腫瘤復發(fā)，排除化療禁忌給予阿霉素聯(lián)合順鉑（AP）方案化療?；煹诙?，患者訴食欲差，加之患者消瘦，醫(yī)師醫(yī)囑甲地孕酮改善食欲，增加體重。,甲地孕酮增加體重、食欲？這是啥原理？,,,說明書資料,,甲地孕酮適應癥：本品適用于晚期乳腺癌和子宮

2、內膜癌的姑息治療不良反應：體重增加：為本品的常見副作用，且常伴有食欲增加。對于癌癥惡液質患者及體重下降、食欲減退的癌癥病人，這種副作用常常是有益的。,查閱文獻驗證？,文獻一：甲地孕酮聯(lián)合化療治療晚期惡性腫瘤105 例,,方法: 入組105 例患者先接受1 周期單獨化療，隨后第2 周期化療開始前2 d 連續(xù)應用甲地孕酮14 d，檢測并分析患者兩周期主要營養(yǎng)指標和惡心/嘔吐的差異。,[1]劉慧龍,李紅英,阮新建,王莉,王飛,劉彥芳.甲地孕

3、酮聯(lián)合化療治療晚期惡性腫瘤105例[J].中國新藥志,2015,24(12):1393-1396.,文獻一：甲地孕酮聯(lián)合化療治療晚期惡性腫瘤105 例,,[1]劉慧龍,李紅英,阮新建,王莉,王飛,劉彥芳.甲地孕酮聯(lián)合化療治療晚期惡性腫瘤105例[J].中國新藥志,2015,24(12):1393-1396.,結論：1、甲地孕酮可改善患者CACS，改善化療期間多項營養(yǎng)指標。2、對于KPS<80分者，甲地孕酮獲益更加顯著。,文獻二

4、：甲地孕酮對終末期惡性腫瘤患者營養(yǎng)狀況、厭食評分及癌因性疲乏的影響,,方法: 入組82 例患者分觀察組41和對照組41，觀察組加用甲地孕酮80mg bid。,[2]薛丹鳳,李湘紅,趙相軍.甲地孕酮對終末期惡性腫瘤患者營養(yǎng)狀況、厭食評分及癌因性疲乏的影響[J].中國藥業(yè),2016,25(9):56-58,59.,文獻二：甲地孕酮對終末期惡性腫瘤患者營養(yǎng)狀況、厭食評分及癌因性疲乏的影響,,[2]薛丹鳳,李湘紅,趙相軍.甲地孕酮對終末期惡性腫

5、瘤患者營養(yǎng)狀況、厭食評分及癌因性疲乏的影響[J].中國藥業(yè),2016,25(9):56-58,59.,文獻二：甲地孕酮對終末期惡性腫瘤患者營養(yǎng)狀況、厭食評分及癌因性疲乏的影響,,[2]薛丹鳳,李湘紅,趙相軍.甲地孕酮對終末期惡性腫瘤患者營養(yǎng)狀況、厭食評分及癌因性疲乏的影響[J].中國藥業(yè),2016,25(9):56-58,59.,兩組治療前厭食評分和 ＣFS 評分亞型及總分無顯著性差異（Ｐ＞0. 05）；兩組與治療前對比，差異具有統(tǒng)計學

6、意義（ Ｐ ＜0. 05）；與對照組治療后對比，觀察組治療后厭食評分和ＣFS 評分亞型及總分明顯下降，差異具有統(tǒng)計學意義（ Ｐ ＜ 0. 05）。詳見表3結論：甲地孕酮可改善CACS狀況,討論,,[3]BUSQUETS S，SEＲPE Ｒ，SIＲISI S，et al． Megestrol acetate:its impact on muscle protein metabolism supports its use in cance

7、rcachexia［J］． Clin Nutr，2010，29(6):733 － 737[4] 趙瑾,李興德,何文志,高敬華,李永生,李際君,史英,柳志寶.奧氮平聯(lián)合醋酸甲地孕酮治療晚期癌癥性厭食癥的療效觀察[J].現代腫瘤醫(yī)學,2015,23(10):1443-1446.[5]陶玉,黃兆明.不同劑量醋酸甲地孕酮對晚期肝癌患者生活質量的影響[J].中國醫(yī)刊,2012,47(2):62-63.,,甲地孕酮治療CACS量化指標,文獻三：

8、Randomized phase III clinical trial of five different arms of treatment in 332 patients with cancer cachexia,,[6] Mantovani G, Macci A, Madeddu C, Serpe R, Massa E, Dess M, Panzone F, Contu P. Randomized phase III clinic

9、al trial of five different arms of treatment in 332 patients with cancer cachexia. Oncologist 2010, 15: 200-11..,Patients and Methods： Three hundred thirty-two assess-ble patients with cancer-related anorexia/cac

10、hexia syn-rome were randomly assigned to one of five treatmentrms: arm 1, medroxyprogeste-rone (500 mg/day) ormegestrol acetate (320 mg/day); arm 2, oral supplementa-on with eicosapentaenoic acid; arm 3, L-carnitine (4/d

11、ay); arm 4, thalidomide (200 mg/day); and arm 5, aombination of the above. Treatment duration was 4months.,文獻三：Randomized phase III clinical trial of five different arms of treatment in 332 patients with cancer cachexia,

12、,[6] Mantovani G, Macci A, Madeddu C, Serpe R, Massa E, Dess M, Panzone F, Contu P. Randomized phase III clinical trial of five different arms of treatment in 332 patients with cancer cachexia. Oncologist 2010, 15: 200-1

13、1..,文獻三：Randomized phase III clinical trial of five different arms of treatment in 332 patients with cancer cachexia,,[6] Mantovani G, Macci A, Madeddu C, Serpe R, Massa E, Dess M, Panzone F, Contu P. Randomized phase II

14、I clinical trial of five different arms of treatment in 332 patients with cancer cachexia. Oncologist 2010, 15: 200-11..,文獻三：Randomized phase III clinical trial of five different arms of treatment in 332 patients with ca

15、ncer cachexia,,[6] Mantovani G, Macci A, Madeddu C, Serpe R, Massa E, Dess M, Panzone F, Contu P. Randomized phase III clinical trial of five different arms of treatment in 332 patients with cancer cachexia. Oncologist 2

16、010, 15: 200-11..,,僅EQ-5D指數評價一項P<0.05，其余指標均無意義,,文獻三：Randomized phase III clinical trial of five different arms of treatment in 332 patients with cancer cachexia,,[3] Mantovani G, Macci A, Madeddu C, Serpe R, Massa E,

17、Dess M, Panzone F, Contu P. Randomized phase III clinical trial of five different arms of treatment in 332 patients with cancer cachexia. Oncologist 2010, 15: 200-11..,,,,,文獻三：Randomized phase III clinical trial of five

18、different arms of treatment in 332 patients with cancer cachexia,,[3] Mantovani G, Macci A, Madeddu C, Serpe R, Massa E, Dess M, Panzone F, Contu P. Randomized phase III clinical trial of five different arms of treatment

19、 in 332 patients with cancer cachexia. Oncologist 2010, 15: 200-11..,,,,,,,,文獻三：Randomized phase III clinical trial of five different arms of treatment in 332 patients with cancer cachexia,,[3] Mantovani G, Macci A, Made

20、ddu C, Serpe R, Massa E, Dess M, Panzone F, Contu P. Randomized phase III clinical trial of five different arms of treatment in 332 patients with cancer cachexia. Oncologist 2010, 15: 200-11..,,討論,1、甲地孕酮對于腫瘤相關的厭食性惡病質綜合征是

21、獲益的。2、但從遠期療效看，單靠甲地孕酮來改善CACS可能是不夠的，還需要二十碳五烯酸、左旋肉堿、沙利度胺等的聯(lián)合治療。,參考文獻,,[1]劉慧龍,李紅英,阮新建,王莉,王飛,劉彥芳.甲地孕酮聯(lián)合化療治療晚期惡性腫瘤105例[J].中國新藥志,2015,24(12):1393-1396[2]薛丹鳳,李湘紅,趙相軍.甲地孕酮對終末期惡性腫瘤患者營養(yǎng)狀況、厭食評分及癌因性疲乏的影響[J].中國藥業(yè),2016,25(9):56-58,59

22、[3]BUSQUETS S，SEＲPE Ｒ，SIＲISI S，et al． Megestrol acetate:its impact on muscle protein metabolism supports its use in cancercachexia［J］． Clin Nutr，2010，29(6):733 － 737[4] 趙瑾,李興德,何文志,高敬華,李永生,李際君,史英,柳志寶.奧氮平聯(lián)合醋酸甲地孕酮治療晚期癌癥性厭

23、食癥的療效觀察[J].現代腫瘤醫(yī)學,2015,23(10):1443-1446.[5]陶玉,黃兆明.不同劑量醋酸甲地孕酮對晚期肝癌患者生活質量的影響[J].中國醫(yī)刊,2012,47(2):62-63.[6] Mantovani G, Macci A, Madeddu C, Serpe R, Massa E, Dess M, Panzone F, Contu P. Randomized phase III clinical trial