甲地孕酮治療cacs

1、,甲地孕酮治療癌癥相關(guān)的厭食性惡病質(zhì)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(nèi)膜樣腺癌術(shù)后1年，持續(xù)腹痛3天”入院?；颊呷朐汉笸晟葡嚓P(guān)檢查，考慮腫瘤復(fù)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欤颊咴V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(shuō)明書資料,,甲地孕酮適應(yīng)癥：本品適用于晚期乳腺癌和子宮

2、內(nèi)膜癌的姑息治療不良反應(yīng)：體重增加：為本品的常見(jiàn)副作用，且常伴有食欲增加。對(duì)于癌癥惡液質(zhì)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(xiàn)驗(yàn)證？,文獻(xiàn)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(dú)化療，隨后第2 周期化療開(kāi)始前2 d 連續(xù)應(yīng)用甲地孕酮14 d，檢測(cè)并分析患者兩周期主要營(yíng)養(yǎng)指標(biāo)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(guó)新藥志,2015,24(12):1393-1396.,文獻(xiàn)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(guó)新藥志,2015,24(12):1393-1396.,結(jié)論：1、甲地孕酮可改善患者CACS，改善化療期間多項(xiàng)營(yíng)養(yǎng)指標(biāo)。2、對(duì)于KPS<80分者，甲地孕酮獲益更加顯著。,文獻(xiàn)二

4、：甲地孕酮對(duì)終末期惡性腫瘤患者營(yíng)養(yǎng)狀況、厭食評(píng)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(duì)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(duì)終末期惡性腫瘤患者營(yíng)養(yǎng)狀況、厭食評(píng)分及癌因性疲乏的影響[J].中國(guó)藥業(yè),2016,25(9):56-58,59.,文獻(xiàn)二：甲地孕酮對(duì)終末期惡性腫瘤患者營(yíng)養(yǎng)狀況、厭食評(píng)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(duì)終末期惡性腫

5、瘤患者營(yíng)養(yǎng)狀況、厭食評(píng)分及癌因性疲乏的影響[J].中國(guó)藥業(yè),2016,25(9):56-58,59.,文獻(xiàn)二：甲地孕酮對(duì)終末期惡性腫瘤患者營(yíng)養(yǎng)狀況、厭食評(píng)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(duì)終末期惡性腫瘤患者營(yíng)養(yǎng)狀況、厭食評(píng)分及癌因性疲乏的影響[J].中國(guó)藥業(yè),2016,25(9):56-58,59.,兩組治療前厭食評(píng)分和 ＣFS 評(píng)分亞型及總分無(wú)顯著性差異（Ｐ＞0. 05）；兩組與治療前對(duì)比，差異具有統(tǒng)計(jì)學(xué)

6、意義（ Ｐ ＜0. 05）；與對(duì)照組治療后對(duì)比，觀察組治療后厭食評(píng)分和ＣFS 評(píng)分亞型及總分明顯下降，差異具有統(tǒng)計(jì)學(xué)意義（ Ｐ ＜ 0. 05）。詳見(jiàn)表3結(jié)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(xiàn)代腫瘤醫(yī)學(xué),2015,23(10):1443-1446.[5]陶玉,黃兆明.不同劑量醋酸甲地孕酮對(duì)晚期肝癌患者生活質(zhì)量的影響[J].中國(guó)醫(yī)刊,2012,47(2):62-63.,,甲地孕酮治療CACS量化指標(biāo),文獻(xiàn)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(xiàn)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(xiàn)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(xiàn)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(shù)評(píng)價(jià)一項(xiàng)P<0.05，其余指標(biāo)均無(wú)意義,,文獻(xiàn)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(xiàn)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(xiàn)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(duì)于腫瘤相關(guān)的厭食性惡病質(zhì)綜合征是

21、獲益的。2、但從遠(yuǎn)期療效看，單靠甲地孕酮來(lái)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(xiàn),,[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(guó)新藥志,2015,24(12):1393-1396[2]薛丹鳳,李湘紅,趙相軍.甲地孕酮對(duì)終末期惡性腫瘤患者營(yíng)養(yǎng)狀況、厭食評(píng)分及癌因性疲乏的影響[J].中國(guó)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(xiàn)代腫瘤醫(yī)學(xué),2015,23(10):1443-1446.[5]陶玉,黃兆明.不同劑量醋酸甲地孕酮對(duì)晚期肝癌患者生活質(zhì)量的影響[J].中國(guó)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