Does Perioperative Oxandrolone Improve Nutritional Status in Patients with Cachexia Related to Head and Neck Carcinoma?

Presentation: AHNS017
Topic: Immunotherapy and Other Adjuvant Treatments
Type: Oral
Date: Wednesday, April 18, 2018
Session: 11:30 AM - 12:20 PM Immunotherapy and Adjuvent Therapies
Authors: Angela M Osmolak, MD, Cristine Klatt-Lasso, MD, Amber Price, MD, Jose A Sanclement, MD, Greg A Krempl, MD
Institution(s): University of Oklahoma Health Science Center

Background: Cancer related cachexia is characterized by progressive weight loss, anorexia, metabolic alterations, depletion of lipid stores and severe muscle wasting which leads to a constant state of catabolism.  In more than 50% of advanced head and neck cancer (HNC) patients, this catabolic state is clinically evident at the time of initial diagnosis. As a result, many of these patients demonstrate difficulties in wound healing in the perioperative period. Anabolic steroids have been studied as an aid in the reversal of this catabolic state. Studies including burn victims, post-operative patients, AIDS wasting myopathy patients, and cancer patients have demonstrated improvements in nitrogen balance, weight, and quality of life measures with the use of anabolic steroids. To date, the potential utility of anabolic steroids in perioperative cachectic HNC patients has not been determined.

Objective:  To investigate the impact of the anabolic steroid, oxandrolone, on the state of cancer cachexia in HNC patients with impaired wound healing during the perioperative period as measured by prealbumin levels and clinical wound healing.

Design: Retrospective review of pre and post oxandrolone administration prealbumin levels in postoperative HNC patients at the University of Oklahoma Health Science Center.

Results: Eighteen patients, aged 44 – 75, received oxandrolone for an average of 22.8 days (range 7-45).  Eleven (61%) were men and seven (39%) were women. The median pre-treatment prealbumin was 88.5 mg/L (range 75 to 160 mg/L).  The median post-treatment prealbumin was 227 mg/L (range 148 to 370 mg/L). The median interval improvement of the prealbumin level was 131.5 mg/L (range 61 to 252 mg/L), which was statistically significant (p<0.001).  The treatment duration to detect improvement in prealbumin levels was 7 – 14 days, with continued increases seen during treatment.  Concurrent improvement in wound healing was also observed.

Conclusion: Perioperative administration of oxandrolone statistically improved nutritional status as measured by prealbumin in perioperative HNC patients. Clinical improvement in the healing of surgical wounds was identified in all patients and correlated with improved prealbumin levels. Oxandrolone administered 10 mg BID may be a useful adjunct in the perioperative care of nutritionally deficient HNC patients.