IS THERE A ROLE FOR MELATONIN IN THE TREATMENT OF NEOPLASTIC CACHEXIA

It is known that neoplastic cachexia shows metabolic characteristics d ifferent from other common causes of malnutrition, and it is mainly du e to an abnormal secretion of TNF, whose levels are often high in pati ents with advanced neoplasia. Previous clinical studies have suggested that the pineal hormone melatonin (MLT), which plays an essential rol e in the neuroendocrine regulation of biological systems, may improve the clinical status of advanced cancer patients and inhibit TNF secret ion. To investigate the relationship between MLT, TNF and cancer-relat ed weight loss, 100 untreatable metastatic solid tumour patients enter ed this study to receive either supportive care alone, or supportive c are plus MLT (20 mg/day orally in the evening). Patients were observed for 3 months, and were considered evaluable when they were observed f or at least 2 months. There were 86 evaluable patients, the other 14 p atients having died from rapid progression of disease. The per cent of weight loss greater than 10% was significantly higher in patients tre ated by supportive care alone than in those concomitantly treated by M LT, with no difference in food intake (P<0.01). Mean serum levels of T NF progressively increased in the supportive care group, but to levels that were not significantly different from pretreatment values. In co ntrast, TNF means concentrations significantly decreased (P<0.05) in p atients concomitantly treated by MLT. These results suggest that the p ineal hormone MLT may be effective in the treatment of the neoplastic cachexia by decreasing TNF blood concentrations. Copyright (C) 1996 El sevier Science Ltd