A Retrospective Study on the Use of Short-Term Combination Pharmacotherapy in Improving Weight, Appetite and Tolerance to Cytotoxic Chemotherapy in Patients with Locally Advanced Solid Cancers
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Abstract
Cytotoxic chemotherapy-related toxicities pose significant challenges in the management of solid cancers, particularly in resource-limited settings. This may be because of the increased incidence of cancer precachexia and cachexia that these patients present with. This retrospective observational study assessed the efficacy of administering a combination of T.Olanzapine (5 mg/day) and Syp.Megestrol acetate (800 mg/day) in improving weight gain, appetite, and tolerance to chemotherapy among undernourished cancer patients (BMI <18 kg/m²) presenting with locally advanced solid cancers. A total of 92 patients who received neoadjuvant chemotherapy or chemoradiotherapy from March 2024- June 2024 were divided into 2 cohorts. The patients in cohort A received the combination for up to six weeks, along with the decided neoadjuvant therapy, while the patients in cohort B did not. Cohort A demonstrated significant improvements in weight gain (≥5% increase observed in 90% of patients, OR = 0.0030, 95% CI: 0.0002–0.0585, p=0.0001) and appetite (VAS score +3 in 20 patients, OR = 0.1294, 95% CI: 0.0265–0.6317, p=0.0115; and SGA improvement in 12 patients, OR = 0.0626, p=0.0596) along with a reduction in chemotherapy-induced nausea and vomiting as compared to the patients in Cohort B. Grade ≥3 hematological toxicity occurred in 5 patients belonging to Cohort B vs. none in cohort A (0%, p=0.046, OR = 0.0310, 95% CI: 0.0016–0.5961, p=0.0213). Patients receiving the combination also showed better treatment adherence and completion rates. The study was concluded on November 30th,2024 after the last patient received their last cycle of chemotherapy and was followed up for 3 weeks to check for adverse events. It thus seems to be an effective strategy in improving patient outcomes, especially in socioeconomically disadvantaged populations with higher prevalence of precachexia and cachexia.
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