Oxandrolone Compared With Megestrol in Preventing Weight Loss in Patients Receiving Chemotherapy for Cancer

Sponsor

Wake Forest University Health Sciences (Other)

Overall Status

Completed

CT.gov ID

NCT00070148

Collaborator

National Cancer Institute (NCI) (NIH)

155

Enrollment

Locations

Arms

Actual Duration (Months)

7.8

Patients Per Site

0.2

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

RATIONALE: Oxandrolone and megestrol may help prevent weight loss and improve quality of life in patients with cancer. It is not yet known whether oxandrolone is more effective than megestrol in preventing weight loss and improving quality of life in patients who are receiving chemotherapy for solid tumors.

PURPOSE: This randomized phase III trial is studying oxandrolone to see how well it works compared to megestrol in preventing weight loss and improving quality of life in patients who are receiving chemotherapy for solid tumors.

Condition or Disease	Intervention/Treatment	Phase
Unspecified Adult Solid Tumor, Protocol Specific Weight Changes	Drug: Megestrol Acetate Drug: Oxandrolone 20 mg	Phase 3

Detailed Description

OBJECTIVES:

Compare the lean body mass and weight of patients with solid tumors and weight loss who are receiving chemotherapy when treated with oxandrolone vs megestrol.
Compare the health-related quality of life of patients treated with these drugs.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to disease stage (I-III vs IV), concurrent radiotherapy (yes vs no), and gender. Patients are randomized to 1 of 2 treatment arms.

Arm I: Patients receive oral oxandrolone twice daily.
Arm II: Patients receive oral megestrol once daily. In both arms, treatment continues for 12 weeks in the absence of excessive weight loss or gain or unacceptable toxicity.

Quality of life, weight, and body composition are assessed at baseline, at 1, 2, and 3 months during study therapy, and then at 1 month after study completion.

Patients are followed at 1 month.

PROJECTED ACCRUAL: A total of 62-155 patients (31-77 per treatment arm) will be accrued for this study within 2 years.

Study Design

Study Type:

Interventional

Actual Enrollment :

155 participants

Allocation:

Randomized

Intervention Model:

Factorial Assignment

Masking:

None (Open Label)

Primary Purpose:

Supportive Care

Official Title:

A Phase III Randomized Study Comparing The Effects Of Oxandrolone (Oxandrin) And Megestrol Acetate (Megace) On Lean Body Mass, Weight, Body Fat, And Quality Of Life In Patients With Solid Tumors And Weight Loss Receiving Chemotherapy

Actual Study Start Date :

Mar 1, 2004

Actual Primary Completion Date :

Aug 1, 2007

Actual Study Completion Date :

Aug 1, 2007

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: Arm 1 Oxandrolone 20 mg daily Oxandrolone 20 mg (10 mg BID) for 12 weeks. 4 additional weeks of follow-up.	Drug: Oxandrolone 20 mg 20 mg/day for 3 months (12 weeks) Other Names: Oxandrolone Oxandrin
Active Comparator: Megace 800 mg Megestrol acetate 800 mg daily for 12 weeks. 4 additional weeks of follow-up.	Drug: Megestrol Acetate Megace by mouth for 12 weeks

Arm

Intervention/Treatment

Active Comparator: Arm 1 Oxandrolone 20 mg daily

Oxandrolone 20 mg (10 mg BID) for 12 weeks. 4 additional weeks of follow-up.

Drug: Oxandrolone 20 mg

20 mg/day for 3 months (12 weeks)

Other Names:

Oxandrolone

Oxandrin

Active Comparator: Megace 800 mg

Megestrol acetate 800 mg daily for 12 weeks. 4 additional weeks of follow-up.

Drug: Megestrol Acetate

Megace by mouth for 12 weeks

Outcome Measures

Primary Outcome Measures

Lean body mass as measured by the Bioelectrical Impedance Analysis monthly [1 month intervals]

Secondary Outcome Measures

Weight [1 month intervals]
Body fat as measured by the Bioelectrical Impedance Analysis monthly [one month intervals]
Health-related quality of life as measured by the Functional Assessment of Cancer Therapy with subscales for anorexia/cachexia and fatigue [one month intervals]
Performance status as measured by ECOG criteria [one month intervals]
Toxicity as measured by standard NCI toxicity criteria [one month interval]

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

INCLUSION CRITERIA:

Age >18 years with no pre-existing or uncontrolled medical or psychological illness that would impair a patient's ability to provide informed consent or to complete protocol therapy or quality of life questionnaires.
A minimum of one month planned chemotherapy remaining at the time Oxandrin or Megestrol acetate is begun. Oral chemotherapy medications, biologicals, and monoclonal antibodies are included in eligibility criteria.
Histologically confirmed solid tumor (see exceptions in ineligibility list)
Female patients with a history of breast cancer, gynecologic cancer, and hormonally responsive germ cell tumors must be disease free > 5 years to be eligible for this study
Patients with non-melanoma skin cancers and carcinoma in situ of the cervix are eligible.
History of weight loss of:

5% total body weight during the previous 6 months OR
3% in previous month OR
Progressive weight loss on 2 consecutive visits despite attempts at dietary, behavioral, or pharmacologic intervention.

ECOG Performance Status of 0-2
Life expectancy > 6 months
Serum creatinine < 2.5mg/dl, SGOT and SGPT < 2 times upper limit of normal, total bilirubin < 2.5 mg/dl
Patients must be able to swallow 1 tablet twice a day or 20 cc of liquid each day
Patients must be able to meet their nutritional requirements via the oral route with food and/or oral supplements or via enteral tube feedings. However, Oxandrin pills must be administered orally.
Patients who are taking warfarin for maintenance of central venous catheter patency are eligible for this trial if their INR < 1.2. Because of the interaction between warfarin and Oxandrin, the maintenance dose of warfarin in eligible patients should be halved to keep the INR at 1-1.2. For example, if a patient is taking 1 mg of warfarin at study entry, it is recommended that the dose be decreased to 0.5 mg per day, their dose should be decreased to every other day, every third day, etc. to keep the INR at < 1.2. The INR must be checked weekly until stable at < 1.2.
Patients can be receiving concurrent RT.

EXCLUSION CRITERIA:

Ongoing or planned treatment with corticosteroid medications, estrogens, progestins (including Megestrol acetate) or any other steroid hormone during the study period. Patients who receive intermittent corticosteroids as part of a pre-chemotherapy antiemetic regimen are eligible for this study. Patients treated with Oxandrin or Megestrol acetate < 3 months before study entry are not eligible. Patients taking dronabinol or any other appetite stimulant must be off medication for a minimum of 3 days prior to start of study medication.
Patients who have had the following are ineligible:
Prostate cancer
Male breast cancer
Female breast, gynecologic, or hormonally responsive germ cell tumors in the last 5 years
Primary or metastatic malignant brain tumors that have not been stable or demonstrate progressive disease in the last 6 months.
Leukemia, lymphoma, myeloma or other hematologic malignancies
Men > 40 years of age should have a prostate-specific antigen (PSA) level checked if not monitored in the past year. Those patients with PSA > 4 ng/mL will be excluded from participation in the study. If required, the PSA should be done within 2 weeks prior to registration.
Patients with hypercalcemia, nephrosis or the nephrotic phase of nephritis or uncontrolled hypertension, congestive heart failure, pulmonary edema, unstable angina or Cushing's syndrome.
Patients with recent (within 6 months) active thromboembolic disease or recent myocardial infarction (within 3 months of study entry).
Systemic anticoagulation: Patients currently on oral anticoagulants (warfarin) are not eligible unless they are taking low doses of warfarin for catheter patency. If a patient develops thromboembolic disease while on treatment, they may remain on study. It is recommended that they receive a standard loading dose of coumadin on day 1. because of the interaction between Oxandrin and Coumadin (Oxandrin elevates the INR), patients will subsequently require a much lower dose of Coumadin. The effect of these combined medications should develop within 24 to 48 hours. The recommended Coumadin dose should be decreased to 20% of what is normally required for sufficient anticoagulation. (Example: If patient would normally receive 5 mg every day, they should only receive 1 mg every day.) PT/INR results should be monitored frequently with dosage adjustment as needed.
Significant ascites, pleural effusions or edema which may inhibit oral food intake or invalidate weight determinations.
Diabetic medications are allowed, however patients taking sulfonyureas are ineligible. Below is a list of commonly used sulfonyureas (Note: This is a helpful guide, not a complete list.):

Glimepiride (Amaryl®), glyburide (DiaBeta®), chlorpropamide (Diabinese®), glipizide(Glucatrol®), combined glyburide and metformin (Glucovance®) and orinase (Tolbutamide®).

There is no contraindication for concomitant use of insulin and oxandrolone (Oxandrin®) if required by the patient. Any patient on insulin or other oral hypoglycemics should self-monitor to prevent hypo & hyperglycemia.

Patients who are pregnant or nursing.
Patients with history of priapism (persistant erections) and sickle cell anemia.
Patients with a BMI(Body Mass Index) ≥ 35

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Helen F. Graham Cancer Center at Christiana Care	Newark	Delaware	United States	19713
2	CCOP - Mount Sinai Medical Center	Miami Beach	Florida	United States	33140
3	Kentuckiana Cancer Institute, PLLC	Louisville	Kentucky	United States	40202
4	Pennington Cancer Center at Baton Rouge General	Baton Rouge	Louisiana	United States	70806
5	MBCCOP - LSU Health Sciences Center	New Orleans	Louisiana	United States	70118
6	Mission Hospitals - Memorial Campus	Asheville	North Carolina	United States	28801
7	Alamance Cancer Center at Alamance Regional Medical Center	Burlington	North Carolina	United States	27216
8	Presbyterian Cancer Center at Presbyterian Hospital	Charlotte	North Carolina	United States	28233-3549
9	CCOP - Southeast Cancer Control Consortium	Goldsboro	North Carolina	United States	27534-9479
10	Southeastern Medical Oncology Center - Goldsboro	Goldsboro	North Carolina	United States	27534
11	Moses Cone Regional Cancer Center at Wesley Long Community Hospital	Greensboro	North Carolina	United States	27403-1198
12	Leo W. Jenkins Cancer Center at ECU Medical School	Greenville	North Carolina	United States	27835-6028
13	Pardee Memorial Hospital	Hendersonville	North Carolina	United States	28791
14	High Point Regional Hospital	High Point	North Carolina	United States	27261
15	Wake Forest University Comprehensive Cancer Center	Winston-Salem	North Carolina	United States	27157-1096
16	CCOP - Columbus	Columbus	Ohio	United States	43215
17	CCOP - Greenville	Greenville	South Carolina	United States	29615
18	CCOP - Upstate Carolina	Spartanburg	South Carolina	United States	29303
19	Danville Regional Medical Center	Danville	Virginia	United States	24541
20	Ravenel Oncology Center at Memorial Hospital of Martinsville and Henry County	Martinsville	Virginia	United States	24115-4788

Sponsors and Collaborators

Wake Forest University Health Sciences
National Cancer Institute (NCI)

Investigators

Study Chair: Edward G. Shaw, MD, Wake Forest University Health Sciences
Principal Investigator: Glenn J. Lesser, MD, Wake Forest University Health Sciences