Medicinal marijuana not tops

Anecdotal reports and previous small studies have indicated that marijuana and its derivatives can be helpful in treating loss ofappetite in cancer patients. However, the first large, multi-institutional, randomized study comparing a marijuana-derived drug, dronabinol (

-9-tetrahydrocannabinol), with a standard appetite stimulant, megestrol acetate,has found that the standard drug is more effective in increasing appetite and weight. The investigation, conducted by the Mayo Clinic (Rochester, MN) and the North Central Cancer Treatment Group, an affiliation of about 20 community clinics throughout the United States, has also found no considerable benefit when the two drugs were used together.

“In patients with advanced cancer, loss of appetite and weight is a major, prevalent problem,” said Aminah Jatoi, a Mayo Clinic oncologist and study researcher. “Often it’s not the chemotherapy or other cancer treatment that contributes to this weight loss. The cancer itself does so for reasons we cannot totally explain.”

This double-blind study of 469 cancer patients, conducted between December 1996 and December 1999, randomly tested the subjects in three sections (J. Clin. Oncol. 2002, 20 (2), 567–573). The first group was given a daily dose of 800 mg of megestrol acetate liquid orally and a placebo capsule; the second group was given 2.5-mg capsules of dronabinol orally twice a day and a liquid placebo; and the third group was given a combination of both medications in the noted dosages. All patients were 18 years of age or older, had been diagnosed with advanced cancer, and had experienced a loss of appetite and/or weight loss of at least five pounds during the preceding two months.

The results showed that 75% of the patients taking megestrol acetate reported an improved appetite, compared with 49% of patients taking dronabinol. In addition, 11% of the megestrol acetate patients gained more than 10% of their baseline weight, compared with only 3% of the dronabinol patients.

“We concluded that, in the doses prescribed in this trial, megestrol acetate is more effective than dronabinol in boosting appetite among patients with advanced cancer,” said Jatoi. Although the trial shows that megestrol acetate improves appetite and increases weight,Jatoi said that it is not the complete answer, and more research needs to be done to find even better medications.

—JULIE L. McDOWELL

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