Prophylactic Versus Reactive Megestrol Acetate Use for Critical Body Weight Loss in Patients with Pharyngeal and Laryngeal Squamous Cell Carcinoma Undergoing Concurrent Chemoradiotherapy

Abstract

This study compared the effects of megestrol acetate (MA) prophylactic (p-MA) versus reactive (r-MA) use for critical body-weight loss (>5% from baseline) during concurrent chemoradiotherapy (CCRT) in patients with advanced pharyngolaryngeal squamous cell carcinoma (PLSCC).

Patients receiving CCRT alone in two phase-II trials were included for analyses. Both the p-MA and r-MA cohorts received the same treatment protocol at the same institution, and the critical body-weight loss, survival, and adverse event profiles were compared.

The mean (SD) weight loss was 5.1% (4.7%) in the p-MA cohort (n = 54) vs. 8.1% (4.6%) in the r-MA cohort (n = 50) (p = .001). The percentage of subjects with body-weight loss >5% was 42.6% in the p-MA cohort vs. 68.0% in the r-MA cohort (p = .011). Tube feeding was needed in 22.2% of p-MA vs. 62.0% of r-MA patients (p < .001). Less neutropenia (26.0% vs. 70.0% [p < .001]) and a shorter duration of grade 3-4 mucositis (2.4 ± 1.4 vs. 3.6 ± 2.0 wk [p = .009]) were observed with p-MA treatment. Disease-specific survival, locoregional control, or distant metastasis-free survival did not differ. Less competing mortality from secondary primary cancer resulted in a better overall survival trend in the p-MA cohort.

p-MA may reduce body-weight loss and improve adverse event profiles during CCRT for patients with PLSCC.

Author Contributions

CY Lin and HM Wang conceived and designed the study. All authors participated in study data collection and interpretation, manuscript preparation, and approved the final manuscript. The corresponding author had final responsibility for the decision to submit for publication.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Informed Consent Statement

Written informed consent was obtained from all patients in the phase-II trials. The requirement to obtain individual informed consent for the present retrospective study was waived by the IRB.

Institutional Review Board Statement

This study was performed in line with the principles of the Declaration of Helsinki. The present study was approved by the Chang Gung Medical Foundation IRB (IRB No.: 201900608B0).

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

The present study was approved by the Chang Gung Medical Foundation IRB (IRB No.: 201900608B0). The authors declare that no funds, grants, or other support was received during the preparation of this manuscript.