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a Geriatric Division, Department of Medicine, VA Medical Center at Northport, New York
b Department of Preventive Medicine, SUNY Medical Center at Stony Brook, New York
c The Rogosin Institute, New York, New York
d Oncology/Immunology Division, Bristol-Myers Squibb Company, Princeton, New Jersey
e Weill Medical College of Cornell University and the New York Presbyterian Hospital, Division of Hematology/Oncology, New York, New York
Shing-shing Yeh, Box 111, VA Medical Center at Northport, 79 Middleville Road, Northport, NY 11768 E-mail: Shingshing.yeh{at}med.va.gov.
Decision Editor: William B. Ershler, MD
Background. Cachexia is associated with elevated levels of cytokines in cancer and human immunodeficiency virus patients. Studies in cancer and acquired immunodeficiency syndrome patients showed that treatment with megestrol acetate (MA) is associated with improvement in appetite and weight gain. Reduction in the levels of cytokines is associated with weight gain in laboratory animals with cancer. This study evaluates the correlation between changes in cytokine (or their receptor) levels and weight following MA treatment in geriatric weight-loss patients.
Methods. Veterans Administration Medical Center nursing home patients (N = 69) with a weight loss of 
5% of usual body weight over the past 3 months or body weight 20% below their ideal body weight participated in a 12-week, randomized, double-blind, placebo-controlled trial, with an additional 13-week follow-up period. Patients were randomly assigned to receive a placebo or MA oral suspension of 800 mg/d for 12 weeks. Levels of the following cytokines (or their receptors) were measured at baseline and after 12 weeks of treatment: tumor necrosis factor soluble receptor (TNFR) subunits, TNFR-p55 and TNFR-p75; interleukin 6 (IL-6); and the soluble interleukin-2 receptor (sIL-2R). The subjects' weight and body composition were measured at the start of the study. Weight and mortality were followed up for another 13 weeks after discontinuing the MA study drug.
Results. Elevated levels of IL-6 in almost all geriatric cachexic patients, compared with normal volunteers (mean, <4.6 pg/ml), were noted at baseline. At 12 weeks after the study drug treatment, there was a decrease in cytokine levels (or their receptors) in the MA group (mean change in IL-6, -3.63 ± 6.62 pg/ml; TNFR-p55, -0.06 ± 0.11 ng/ml; TNFR-p75, -0.01 ± 0.29 ng/ml; and sIL-2R, 0.08 ± 0.07 ng/ml) and the placebo group (mean change in IL-6, -2.08 ± 3.92 pg/ml; TNFR-p55, -0.02 ± 0.08 ng/ml; TNFR-p75, -0.20 ± 0.18 ng/ml; and sIL-2R, 0.02 ± 0.03 ng/ml). Although the change in cytokine levels was not statistically significant between the two groups, significant negative correlation (p < .05) was found. For example, increased weight correlated with decreased sIL-2R levels (r = -.36) and TNFR-p75 (r = -.31; fat-free mass (FFM) gain and reduction of sIL-2R (r = -.39), TNFR-p75 (r = -.30). There was a significant correlation between weight gain and reduction of TNFR-p75 (r = -.54), TNFR-p55 (r = -.47), and sIL-2R (r = -.53); FFM gain and reduction of sIL-2R (r = -.59), TNFR-p75 (r = -.41), TNFR-p55 (r = -.42); and fat gain and reduction of TNFR-p75 (r = -.41) in the MA group (p < .05), but not in the placebo group.
Conclusions. Although there was no significant change in cytokine levels between the two groups, the reduction in cytokine levels after MA treatment correlated with improvement in weight, fat mass, and FFM at 12 weeks.
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