EFFICACY OF MULTIMODAL THERAPY IN DELAYING PRECACHEXIA PROGRESSION IN PATIENTS WITH REPRODUCTIVE ORGAN CANCERS
Keywords:
precachexia, reproductive organ cancer, multimodal therapy, inflammatory markers, weight stabilization, quality of lifeAbstract
Objective: To evaluate the impact of combination therapy on inflammatory markers and metabolic parameters in stage IV ovarian, endometrial, and cervical cancer patients with precachexia. Materials and Methods: A prospective cohort study enrolled 55 women between 2023 and 2024. Eligible patients had confirmed precachexia according to Fearon criteria and ECOG performance status 1-2. The therapeutic regimen comprised celecoxib (400 mg/day), megestrol acetate (320-480 mg/day), omega-3 polyunsaturated fatty acids (2 g eicosapentaenoic acid/day), metformin (1500-2000 mg/day), and nutritional support. Follow-up duration was 24 weeks. Primary endpoints included C-reactive protein (CRP) dynamics, body weight stabilization, and appetite improvement assessed by FAACT scale. Secondary parameters encompassed interleukin-6, tumor necrosis factor-alpha, albumin levels, quality of life measured by EORTC QLQ-C30, and time to cachexia progression. Results: At week 4, median CRP decreased from 18.5 mg/L to 14.2 mg/L (23.2% reduction; p<0.001). Body weight stabilization occurred in 22 patients (40.0%) within 12 weeks. Appetite improvement was documented in 26 patients (47.3%). Interleukin-6 declined by 34.9% over 24 weeks (p<0.001), tumor necrosis factor-alpha by 21.8% (p<0.001). Albumin levels increased from 32.1 to 35.1 g/L (p<0.001). Global health status on EORTC QLQ-C30 improved from 42.3 to 53.8 points (p<0.001). Cachexia progression continued in 18 patients (32.7%). Grade 3-4 adverse events affected 12.7% of patients, predominantly gastrointestinal disorders. Conclusion: Multimodal therapy delays precachexia progression, reduces systemic inflammation markers, and enhances quality of life.vHowever, weight gain remains limited (20%), and cachexia progression persists in one-third of patients. Despite acceptable safety profile, more effective strategies are needed.
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