Clinical implication of megestrol acetate in advanced cancer: A big data analysis from Health Insurance Review and Assessment (HIRA) database

Abstract Purpose Megestrol acetate (MA) is used to manage anorexia and cachexia in patients with advanced cancer. This study investigated prescription patterns and impact on the survival and the venous thromboembolism (VTE) of MA in patients with advanced cancer.Methods In this study, a Health Insurance Review and Assessment (HIRA) service database was used to investigate differences in baseline characteristics, survival, and the incidence of VTE according to MA prescription patterns (i.e., prescription vs. no prescription) in patients diagnosed with metastatic gastric, colorectal, and pancreatobiliary cancers from July 2014 to December 2015.Results A total of 5,920 patients were included in this study. In total, 66.9% of the patients were prescribed MA. Pancreatobiliary cancer, older age, treatment in tertiary hospitals, and palliative chemotherapy were statistically significant predictive factors for MA prescription. Continuous prescription of MA was observed in 42.2% of patients. There was no statistically significant difference in survival between the MA and non-MA prescription groups. Among the 4,081 patients included in the analysis for VTE incidence, 5.4% and 2.9% were diagnosed with VTE during the follow-up period in the MA and non-MA prescription groups, respectively. However, there was no statistically significant difference in VTE diagnosis between the groups on multivariate analysis.Conclusions This study demonstrated that most patients with advanced gastrointestinal and pancreatobiliary cancer required MA prescription. The difference in the incidence of VTE was modest between the MA and non-MA prescription groups (not at the level of statistical significance on multivariate analyses).