甲地孕酮治疗CACS.ppt

,甲地孕酮治疗癌症相关的厌食性恶病质综合征(CACS),肿瘤专业：段继洪,病例资料,一、选题背景,患者，女，55岁，因“子宫内膜样腺癌术后1年，持续腹痛3天”入院。患者入院后完善相关检查，考虑肿瘤复发，排除化疗禁忌给予阿霉素联合顺铂（AP）方案化疗。化疗第二天，患者诉食欲差，加之患者消瘦，医师医嘱甲地孕酮改善食欲，增加体重。,甲地孕酮增加体重、食欲？这是啥原理？,说明书资料,甲地孕酮 适应症：本品适用于晚期乳腺癌和子宫内膜癌的姑息治疗 不良反应：体重增加：为本品的常见副作用，且常伴有食欲增加。对于癌症恶液质患者及体重下降、食欲减退的癌症病人，这种副作用常常是有益的。,查阅文献验证？,文献一：甲地孕酮联合化疗治疗晚期恶性肿瘤105 例,方法: 入组105 例患者先接受1 周期单独化疗，随后第2 周期化疗开始前2 d 连续应用甲地孕酮14 d，检测并分析患者两周期主要营养指标和恶心/呕吐的差异。,1刘慧龙,李红英,阮新建,王莉,王飞,刘彦芳.甲地孕酮联合化疗治疗晚期恶性肿瘤105例J.中国新药志,2015,24(12):1393-1396.,文献一：甲地孕酮联合化疗治疗晚期恶性肿瘤105 例,1刘慧龙,李红英,阮新建,王莉,王飞,刘彦芳.甲地孕酮联合化疗治疗晚期恶性肿瘤105例J.中国新药志,2015,24(12):1393-1396.,结论： 1、甲地孕酮可改善患者CACS，改善化疗期间多项营养指标。 2、对于KPS80分者，甲地孕酮获益更加显著。,文献二：甲地孕酮对终末期恶性肿瘤患者营养状况、厌食评分及癌因性疲乏的影响,方法: 入组82 例患者分观察组41和对照组41，观察组加用甲地孕酮80mg bid。,2薛丹凤,李湘红,赵相军.甲地孕酮对终末期恶性肿瘤患者营养状况、厌食评分及癌因性疲乏的影响J.中国药业,2016,25(9):56-58,59.,文献二：甲地孕酮对终末期恶性肿瘤患者营养状况、厌食评分及癌因性疲乏的影响,2薛丹凤,李湘红,赵相军.甲地孕酮对终末期恶性肿瘤患者营养状况、厌食评分及癌因性疲乏的影响J.中国药业,2016,25(9):56-58,59.,文献二：甲地孕酮对终末期恶性肿瘤患者营养状况、厌食评分及癌因性疲乏的影响,2薛丹凤,李湘红,赵相军.甲地孕酮对终末期恶性肿瘤患者营养状况、厌食评分及癌因性疲乏的影响J.中国药业,2016,25(9):56-58,59.,两组治疗前厌食评分和 FS 评分亚型及总分无显著性差异（0. 05）；两组与治疗前对比，差异具有统计学意义（ 0. 05）；与对照组治疗后对比，观察组治疗后厌食评分和FS 评分亚型及总分明显下降，差异具有统计学意义（ 0. 05）。详见表3 结论：甲地孕酮可改善CACS状况,讨论,3BUSQUETS S，SEPE ，SIISI S，et al Megestrol acetate:its impact on muscle protein metabolism supports its use in cancercachexiaJ Clin Nutr，2010，29(6):733 737 4 赵瑾,李兴德,何文志,高敬华,李永生,李际君,史英,柳志宝.奥氮平联合醋酸甲地孕酮治疗晚期癌症性厌食症的疗效观察J.现代肿瘤医学,2015,23(10):1443-1446. 5陶玉,黄兆明.不同剂量醋酸甲地孕酮对晚期肝癌患者生活质量的影响J.中国医刊,2012,47(2):62-63.,甲地孕酮治疗CACS量化指标,文献三：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 III clinical 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/cachexia 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/day); arm 4, thalidomide (200 mg/day); and arm 5, aombination of the above. Treatment duration was 4months.,文献三：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 III clinical trial of five different arms of treatment in 332 patients with cancer cachexia. Oncologist 2010, 15: 200-11,文献三：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 III clinical trial of five different arms of treatment in 332 patients with cancer cachexia. Oncologist 2010, 15: 200-11,文献三：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 III clinical trial of five different arms of treatment in 332 patients with cancer cachexia. Oncologist 2010, 15: 200-11,仅EQ-5D指数评价一项P0.05，其余指标均无意义,文献三：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, 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,文献三：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, 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,文献三：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, 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,讨论,1、甲地孕酮对于肿瘤相关的厌食性恶病质综合征是获益的。 2、但从远期疗效看，单靠甲地孕酮来改善CACS可能是不够的，还需要二十碳五烯酸、左旋肉碱、沙利度胺等的联合治疗。,参考文献,1刘慧龙,李红英,阮新建,王莉,王飞,刘彦芳.甲地孕酮联合化疗治疗晚期恶性肿瘤105例J.中国新药志,2015,24(12):1393-1396 2薛丹凤,李湘红,赵相军.甲地孕酮对终末期恶性肿瘤患者营养状况、厌食评分及癌因性疲乏的影响J.中国药业,2016,25(9):56-58,59 3BUSQUETS S，SEPE ，SIISI S，et al Megestrol acetate:its impact on muscle protein metabolism supports its use in cancercachexiaJ Clin Nutr，2010，29(6):733 737 4 赵瑾,李兴德,何文志,高敬华,李永生,李际君,史英,柳志宝.奥氮平联合醋酸甲地孕酮治疗晚期癌症性厌食症的疗效观察J.现代肿瘤医学,2015,23(10):1443-1446. 5陶玉,黄兆明.不同剂量醋酸甲地孕酮对晚期肝癌患者生