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DOI: 10.1055/s-0042-1742616
Megestrol Acetate in the Treatment of Post COVID-19 Fatigue in a Patient of Advanced Cancer: A Case Report and Mini Review of Literature
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Abstract
Megestrol acetate is one of the pharmacological agents used for cancer-associated fatigue. To date, there are no studies on its use in the treatment of post-COVID-19 (coronavirus disease 2019) fatigue. So, we report a case of metastatic carcinoma lung with a partial response with three cycles of palliative chemotherapy. He was contracted with mild COVID-19 infection post three cycles of his chemotherapy. Post this episode, fatigue was his main and most troublesome symptom. After a thorough clinical history, physical examination, and investigations, type 2 post-COVID-19 syndrome was diagnosed. After explaining the risks and benefits, we started the patient on low-dose megestrol acetate (160 mg/d per oral) with low to moderate benefits. However, upon increasing the dose to 480 mg/d, the benefit on the subjective quality of life was significant. Studies with a larger sample and randomized controlled trials have to be conducted to substantiate the hypothesis and actual effect of megestrol acetate in the treatment of post-COVID-19 fatigue.
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Publikationsverlauf
Artikel online veröffentlicht:
14. April 2022
© 2022. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Rosenthal TC, Majeroni BA, Pretorius R, Malik K. Fatigue: an overview. Am Fam Physician 2008; 78 (10) 1173-1179
- 2 Greenberg DB. Clinical dimensions of fatigue. Prim Care Companion J Clin Psychiatry 2002; 4 (03) 90-93
- 3 Curt GA. Impact of fatigue on quality of life in oncology patients. Semin Hematol 2000; 37 (4, suppl 6): 14-17
- 4 Flechtner H, Bottomley A. Fatigue and quality of life: lessons from the real world. Oncologist 2003; 8 (1, suppl 1): 5-9
- 5 Yoo EH, Choi ES, Cho SH, Do JH, Lee SJ, Kim JH. Comparison of fatigue severity and quality of life between unexplained fatigue patients and explained fatigue patients. Korean J Fam Med 2018; 39 (03) 180-184
- 6 Garrigues E, Janvier P, Kherabi Y. et al. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J Infect 2020; 81 (06) e4-e6
- 7 Scordo KA, Richmond MM, Munro N. Post-COVID-19 syndrome: theoretical basis, identification, and management. AACN Adv Crit Care 2021; 32 (02) 188-194
- 8 Maltezou HC, Pavli A, Tsakris A. Post-COVID syndrome: an insight on its pathogenesis. Vaccines (Basel) 2021; 9 (05) 497
- 9 Mantovani G, Macciò A, Madeddu C. et al. Randomized phase III clinical trial of five different arms of treatment in 332 patients with cancer cachexia. Oncologist 2010; 15 (02) 200-211
- 10 Bruera E, Ernst S, Hagen N. et al. Effectiveness of megestrol acetate in patients with advanced cancer: a randomized, double-blind, crossover study. Cancer Prev Control 1998; 2 (02) 74-78
- 11 Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 1991; 7 (02) 6-9
- 12 Aguilar RB, Hardigan P, Mayi B. et al. Current understanding of COVID-19 clinical course and investigational treatments. Front Med (Lausanne) 2020; 7: 555301
- 13 Thevarajan I, Buising KL, Cowie BC. Clinical presentation and management of COVID-19. Med J Aust 2020; 213 (03) 134-139
- 14 Schwartz LH, Litière S, de Vries E. et al. RECIST 1.1-Update and clarification: from the RECIST committee. Eur J Cancer 2016; 62: 132-137
- 15 Becker RC. COVID-19 and its sequelae: a platform for optimal patient care, discovery and training. J Thromb Thrombolysis 2021; 51 (03) 587-594
- 16 Morens DM, Breman JG, Calisher CH. et al. The origin of COVID-19 and why it matters. Am J Trop Med Hyg 2020; 103 (03) 955-959
- 17 Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R. COVID-19 infection: origin, transmission, and characteristics of human coronaviruses. J Adv Res 2020; 24: 91-98
- 18 Bhandari S, Bhargava A, Sharma S, Keshwani P, Sharma R, Banerjee S. Clinical profile of COVID-19 infected patients admitted in a tertiary care hospital in North India. J Assoc Physicians India 2020; 68 (05) 13-17
- 19 de Souza R, Mhatre S, Qayyumi B. et al. Clinical course and outcome of patients with COVID-19 in Mumbai city: an observational study. BMJ Open 2021; 11 (05) e042943
- 20 Budhiraja S, Soni A, Jha V. et al. Clinical profile of first 1000 COVID-19 cases admitted at tertiary care hospitals and the correlates of their mortality: an Indian experience. medRxiv 2020:2020.11.16.20232223
- 21 Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ 2020; 370: m3026
- 22 Maccarone MC, Magro G, Tognolo L, Masiero S. Post COVID-19 persistent fatigue: a proposal for rehabilitative interventions in the spa setting. Int J Biometeorol 2021; 65 (12) 2241-2243
- 23 Vink M, Vink-Niese A. Could cognitive behavioural therapy be an effective treatment for long COVID and post COVID-19 fatigue syndrome? Lessons from the Qure Study for Q-Fever Fatigue Syndrome. Healthcare (Basel) 2020; 8 (04) E552
- 24 Balog DL, Epstein ME, Amodio-Groton MI. HIV wasting syndrome: treatment update. Ann Pharmacother 1998; 32 (04) 446-458
- 25 Loprinzi CL, Ellison NM, Goldberg RM, Michalak JC, Burch PA. Alleviation of cancer anorexia and cachexia: studies of the Mayo Clinic and the North Central Cancer Treatment Group. Semin Oncol 1990; 17 (6, suppl 9): 8-12
- 26 Gill PG, Gebski V, Snyder R. et al. Randomized comparison of the effects of tamoxifen, megestrol acetate, or tamoxifen plus megestrol acetate on treatment response and survival in patients with metastatic breast cancer. Ann Oncol 1993; 4 (09) 741-744
- 27 Yeh S-S, Schuster MW. Megestrol acetate in cachexia and anorexia. Int J Nanomedicine 2006; 1 (04) 411-416
- 28 Ruiz-García V, López-Briz E, Carbonell-Sanchis R, Bort-Martí S, Gonzálvez-Perales JL. Megestrol acetate for cachexia-anorexia syndrome. A systematic review. J Cachexia Sarcopenia Muscle 2018; 9 (03) 444-452
- 29 Currow DC, Glare P, Louw S. et al. A randomised, double blind, placebo-controlled trial of megestrol acetate or dexamethasone in treating symptomatic anorexia in people with advanced cancer. Sci Rep 2021; 11 (01) 2421
- 30 Loprinzi CL, Michalak JC, Quella SK. et al. Megestrol acetate for the prevention of hot flashes. N Engl J Med 1994; 331 (06) 347-352
- 31 Yeh S, Wu SY, Levine DM. et al. Quality of life and stimulation of weight gain after treatment with megestrol acetate: correlation between cytokine levels and nutritional status, appetite in geriatric patients with wasting syndrome. J Nutr Health Aging 2000; 4 (04) 246-251
- 32 Argilés JM, Anguera A, Stemmler B. A new look at an old drug for the treatment of cancer cachexia: megestrol acetate. Clin Nutr 2013; 32 (03) 319-324
- 33 House L, Seminerio MJ, Mirkov S. et al. Metabolism of megestrol acetate in vitro and the role of oxidative metabolites. Xenobiotica 2018; 48 (10) 973-983
- 34 Saeed S, Tadic M, Larsen TH, Grassi G, Mancia G. Coronavirus disease 2019 and cardiovascular complications: focused clinical review. J Hypertens 2021; 39 (07) 1282-1292
- 35 Mitrani RD, Dabas N, Goldberger JJ. COVID-19 cardiac injury: Implications for long-term surveillance and outcomes in survivors. Heart Rhythm 2020; 17 (11) 1984-1990
- 36 Webmd.com. Interactions of Megestrol acetate [updated 20 Feb 2020]. Accessed November 23, 2021 at: https://www.webmd.com/drugs/2/drug-8946-8300/megestrol-oral/megestrol-suspension-oral/details/list-interaction-medication
- 37 Go.drugbank.com. Drug interactions with Megestrol acetate [updated 20 Feb 2020]. Accessed November 23, 2021 at: https://go.drugbank.com/drugs/DB00351