WO2009056256A1

WO2009056256A1 - Use of megestrol acetate having improved solubility for the treatment of cancer cachexia

Info

Publication number: WO2009056256A1
Application number: PCT/EP2008/008967
Authority: WO
Inventors: Stefan Anker; Jochen Springer
Original assignee: Par Pharmaceuticals, Inc.
Priority date: 2007-11-02
Filing date: 2008-10-23
Publication date: 2009-05-07

Abstract

The present invention relates to the treatment of cancer patients suffering from cachexia as a co-morbidity with a megestrol acetate formulation (MegaceTM ES) having improved solubility.

Description

Par Pharmaceutical, Inc.

Use of megestrol acetate having improved solubility for the treatment of cancer cachexia

The present invention relates to the treatment of patients suffering from cachexia as a comorbidity of cancer using megestrol acetate (MA), in particular using megestrol acetate oral suspension (Megace™), more precisely using the advanced nanoparticulate formulation of megestrol acetate oral suspension having improved solubility and bioavailability (Megace ES).

Background of the invention

In modern society cancer is one of the most prevalent diseases and a major contributor to rising health care costs. Cachexia is a very common co-morbidity in cancer patients which drastically reduces quality of life and survival. In an estimated 22% of cancer patients the exact cause of death is cachexia.

Megestrol acetate (MA) is a synthetically produced derivative of the naturally occurring steroid hormone progesterone. Megestrol acetate is a white, crystalline substance having the chemical name 17-α-acetoxy-6-methylpregna-4,6-diene-3,20-dione (C₂₄H₃₂O₄) and a molecular weight of 384.5. Megestrol acetate has the following formula:

It is known that megestrol acetate is primarily excreted via the kidneys; however, the mechanisms that affect bio-availability are not completely elucidated. Megestrol acetate is the main agent of the pharmaceutical product Megace® from Bristol-Myers Squibb Company which either has the formulation as an orally active solution or as a tablet (see also EP 0 338 404).

In clinical medicine, megestrol acetate is used as an appetite stimulant that acts by a still unknown mechanism. Initially, megestrol acetate was used for the inhibition of malignant post-menopausal hormone dependent tumours of the breast [Gregory EJ, Cohen SC. Megestrol acetate therapy for advanced breast cancer. J Clin Oncol 1985; 3:155-160. Benghiat A, Cassidy SA. Megestrol acetate in the treatment of advanced post-menopausal breast cancer. Eur J Surg Oncol 1986 12: 43-45, Goss PE. Pre-clinical and clinical review of vorozole, a new third generation aromatoase inhibitor. Report. Breast Cancer Res Tr 1998; 49: S59-S65] and the prostate [Keller J, White JM. A phase III randomised comparative trial of megestrol acetate v. diethylstilbestrol in stage D2 prostatic cancer. Preliminary results. Proc Am Soc Clin Oncol 1986, 5:421. Bonomi P, Pessis D, Bunting N, et al. Megestrol acetate used as primary hormonal therapy in stage D prostatic cancer. Semin Oncol 1985; 12 (Suppl 1): 36-39]. While using it, an increase of weight and appetite stimulation was discovered as side effects. Initially, a dose of 30 mg/d [Stoll BA. Progestin therapy of breast cancer: comparison of agents. Br Med J 1967; 3: 338-341] was used.

So far, megestrol acetate has been used for several years successfully in cachexia of patients having mammary carcinoma or other malignant tumours. In Germany, this drug is only registered for the therapy in progressed mammary carcinoma. For a specific therapy in patients with mammary carcinoma in phase IV for improving the quality of life, the dosages 160 mg/d, 800 mg/d and 1600 mg/d were compared in the CALGB-study and 160 mg/d was found as the optimal dosage [Kornblinth AB, Hollis DR, Zuckerman E, et al. Effect of megestrol acetate on quality of life in a dose-response trial in woman with advanced breast cancer. J Clin Oncol 1993; 11 : 2081-2089].

US 6,268,356 describes an oral pharmaceutical composition in the form of a stable flocculated suspension in water comprising: megestrol acetate; at least one compound selected from the group consisting of polyethylene glycol, propylene glycol, glycerol, and sorbitol; and a surfactant, wherein polysorbate and polyethylene glycol are not simultaneously present.

Recently, a novel substance herein below designated as "novel Megace™" has been introduced that is also designated as "Megace™ ES". Novel Megace™ essentially is the same medication as the commonly used megestrol acetate, but having a micro-crystalline structure which significantly improves resorption. Both oral suspensions contain the same active agent; however, Megace™ ES has a different formulation whereby resorption is significantly improved. Par Pharmaceutical, Inc. manufactures this advanced formulation, as disclosed in the PCT application WO 03/086354 Al. The improvement is caused by a nanoparticulate composition comprising megestrol acetate and preferably at least one surface stabilizer associated with the surface of the drug. These nanoparticulate megestrol particles have an effective average particle size of less than about 2000 nm. This advanced formulation, in a preferred embodiment thereof, utilises NanoCrystal™ Dispersion technology to improve the bioavailablity of the drug as compared to alternative, non- particulate formulations of the product as disclosed in WO 04/050059. In said patent publication, the product is disclosed as a low viscosity liquid dosage form comprising particles of an active agent, a surface stabilizer, and a pharmaceutically acceptable excipient, carrier, or a combination thereof, wherein the active agent particles have an effective average particle size of less than about 2 microns and the dosage form has a viscosity of less than about 2000 mPa.s at a shear rate of 0.1 (1/s). NanoCrystal™ Dispersion is a trademark of Elan Corporation, pic, Dublin, Ireland. Megace™ is a registered trademark of Bristol-Myers Squibb Company licensed to Par Pharmaceutical, Inc. With Megace™ ES, this reduction in bioavailability is minimized in the fasted state, resulting in improved bioavailability in patients who have not eaten. Megace ^M ES 625 mg/5 ml and megestrol acetate oral suspension 800 mg/20 ml are bioequivalent in a fed state.

The reference Drugs R D. 2007;8 (6):403-6 also describes megestrol acetate Megace™ ES 625mg/5ml) oral suspension for the treatment of anorexia, cachexia or an unexplained, significant weight loss in patients with AIDS. A more rapid onset of action, more convenient dosing and a lower dosing regimen compared with the original marketed formulation of megestrol acetate oral suspension is described. Patients are administered a teaspoon (5ml) of the new NCD formulation once daily, compared with a daily 20ml dosage cup of the original formulation. The megestrol acetate NCD formulation represents a line-extension of Par's megestrol acetate oral suspension (40mg/ml or 800mg/20ml), which has been marketed for anorexia, cachexia or an unexplained, significant weight loss in patients with AIDS since July 2001.

US 7,101,576 to Elan Pharma International describes Megace™ ES 625 mg/5ml oral suspension. The patent includes claims relating to the advanced formulation of megestrol acetate, specifically, to the reduction of the food effect seen with previous formulations of megestrol acetate.

For megestrol acetate, anti-androgene, anti-estrogene and small glucocorticoid-similar effects are assumed [Alexieva-Figusch J, Van Glise HA. Progestin therapy in advanced breast cancer: Megestrol acetate -An evaluation of 160 treated cases. Cancer 1980; 46: 2369-2372].

Improved treatments of cancer are always sought for. Thus, the object of the present invention is to provide an improved treatment of cancer, in particular cancer cachexia as a co-morbidity, in order to reduce the severity of, as well as the disability and mortality associated with the diseases.

The object of the present invention is, in one particular aspect thereof, solved by the use of megestrol acetate or a pharmaceutically acceptable salt thereof, optionally with appropriate adjuvants and additives for the therapy or improvement of cachexia as a co-morbidity of cancer, herein also designated "cancer-cachexia" or "cachexia associated with cancer".

In the literature there is no claim or evidence that megestrol acetate is a useful drug in the treatment of cachexia as a co-morbidity of cancer. Cancer-cachexia can be defined according to, for example, the publication of Fearon et al. (Fearon KC, Voss AC, Hustead DS; Cancer Cachexia Study Group. Definition of cancer cachexia: effect of weight loss, reduced food intake, and systemic inflammation on functional status and prognosis. Am J Clin Nutr. 2006 Jun;83(6): 1345-50) and/or the references as cited therein.

Based on an animal model, the pulmonary influence of the appetite stimulant megestrol acetate in cancer-cachexia was analysed. Surprisingly, these experiments revealed, that the use of megestrol acetate oral suspension results in a reduction of fat- and muscle wasting. Furthermore, food intake and locomotor activity as indicators of quality of life were higher in animals treated with higher doses of MegaceES™ as well. Cardiac function was improved, as shown by a better ejection fraction, fractional shortening and a reduced end-systolic volume. Most importantly, MegaceES™ improved survival.

Megestrol acetate useable according to the present invention can be provided in any number of forms suitable for administration. Suitable pharmaceutically acceptable forms comprise salts or pre or pro-forms of megestrol acetate. Preferred is an oral liquid form. Examples of pharmaceutically acceptable salts comprise without limitation non toxic inorganic or organic salts such as acetate derived from acetic acid, aconitate derived from aconitic acid, ascorbate derived from ascorbic acid, benzoate derived from benzoic acid, cinnamate derived from cinnamic acid, citrate derived from citric acid, embonate derived from embonic acid, enantate derived from heptanoic acid, formiate derived from formic acid, fumarate derived from fumaric acid, glutamate derived from glutamic acid, glycolate derived from glycolic acid, chloride derived from hydrochloric acid, bromide derived from hydrobromic acid, lactate derived from lactic acid, maleate derived from maleic acid, malonate derived from malonic acid, mandelate derived from mandelic acid, methanesulfonate derived from methanesulfonic acid, naphtaline-2-sulfonate derived from naphtaline-2-sulfonic acid, nitrate derived from nitric acid, perchlorate derived from perchloric acid, phosphate derived from phosphoric acid, phthalate derived from phthalic acid, salicylate derived from salicylic acid, sorbate derived from sorbic acid, stearate derived from stearic acid, succinate derived from succinic acid, sulphate derived from sulphuric acid, tartrate derived from tartaric acid, toluene-p-sulfate derived from p-toluene-sulfonic acid and others. Such salts can be produced by methods known to someone of skill in the art and described in the prior art.

Other salts like oxalate derived from oxalic acid, which is not considered as pharmaceutically acceptable salt can be appropriate as intermediates for the production of megestrol acetate or a pharmaceutically acceptable salt thereof.

Megestrol acetate or a pharmaceutically acceptable salt thereof can be bound to microcarriers or nanoparticles in parenterals like, for example, finely dispersed particles based on poly(meth)acrylates, polylactates, polyglycolates, polyamino acids or polyether urethanes. Parenteral formulations can also be modified as depot preparations, e.g. based on the "multiple unit principle", if megestrol acetate or a pharmaceutically acceptable salt thereof is introduced in finely dispersed, dispersed and suspended form, respectively, or as a suspension of crystals in the medicament or based on the "single unit principle" if megestrol acetate or a pharmaceutically acceptable salt thereof is enclosed in a formulation, e.g. in a tablet or a rod which is subsequently implanted. These implants or depot medicaments in single unit and multiple unit formulations often consist out of so-called biodegradable polymers like e.g. polyesters of lactic and glycolic acid, polyether urethanes, polyamino acids, poly(meth)acrylates or polysaccharides. Adjuvants and carriers added during the production of the medicaments usable according to the present invention formulated as parenterals are preferably aqua sterilisata (sterilised water), pH value influencing substances like, e.g. organic or inorganic acids or bases as well as salts thereof, buffering substances for adjusting pH values, substances for isotonisation like e.g. sodium chloride, sodium hydrogen carbonate, glucose and fructose, tensides and surfactants, respectively, and emulsifiers like, e.g. partial esters of fatty acids of polyoxyethylene sorbitans (for example, Tween^®) or, e.g. fatty acid esters of polyoxyethylenes (for example, Cremophor^®), fatty oils like, e.g. peanut oil, soybean oil or castor oil, synthetic esters of fatty acids like, e.g. ethyl oleate, isopropyl myristate and neutral oil (for example, Miglyol^®) as well as polymeric adjuvants like, e.g. gelatine, dextran, polyvinylpyrrolidone, additives which increase the solubility of organic solvents like, e.g. propylene glycol, ethanol, N,N-dimethylacetamide, propylene glycol or complex forming substances like, e.g. citrate and urea, preservatives like, e.g. benzoic acid hydroxypropyl ester and methyl ester, benzyl alcohol, antioxidants like e.g. sodium sulfite and stabilisers like e.g. EDTA.

When formulating the medicaments usable according to the present invention as suspensions, in a preferred embodiment, thickening agents are employed to prevent the setting of megestrol acetate or a pharmaceutically acceptable salt thereof, and tensides and polyelectrolytes to assure the resuspendability of sediments and/or complex forming agents like, for example, EDTA are added. It is also possible to achieve complexes of the active ingredient with various polymers. Examples of such polymers are polyethylene glycol, polystyrol, carboxymethyl cellulose, Pluronics^® or polyethylene glycol sorbitol fatty acid ester. Megestrol acetate or a pharmaceutically acceptable salt thereof can also be incorporated in liquid formulations in the form of inclusion compounds e.g. with cyclodextrins. In particular embodiments dispersing agents can be added as further adjuvants. For the production of lyophilisates, scaffolding agents like mannite, dextran, sucrose, human albumin, lactose, PVP or varieties of gelatine can be used.

In as far as megestrol acetate is not included in a liquid drug formulation in its basic form, it can be employed within the parenterals in the form of its acid addition salt solvates.

A further important systemic application formulation is peroral administration in the form of tablets, hard or soft gelatine capsules, coated tablets, powders, pellets, microcapsules, compressed oblongs, granulates, cachets, lozenges, troches, chewing gum or sachets. These solid perorally administered formulations can also be formulated as retard and depot systems, respectively. Comprised therein are medicaments with a content of one or more micronised active agents, diffusion and erosion forms based on matrix, e.g. by using fats, waxy or polymeric substances or so-called reservoir systems. If the medicament is formulated to release megestrol acetate over a prolonged period of time, retarding agents and agents for the controlled release, respectively, can be added like film or matrix forming substances, for example, ethylcellulose, hydroxypropyl methyl cellulose, poly(meth)acrylate derivatives, (e.g. Eudragit™), hydroxypropyl-methylcellulose phthalate both in organic solutions and in the form of aqueous dispersions. In this context, bioadhesive preparations should also be mentioned wherein an extended dwelling time in the body is caused by the intimate contact with the mucous membranes of the body. An example of a bioadhesive polymer is, e.g. the group of Carbomere™.

For the purpose of a controlled release of megestrol acetate or a pharmaceutically acceptable salt thereof within the different segments of the gastro-intestinal tract it is possible to employ a mixture of pellets which release at different locations. The medicament formulation can be coated, for example, with mixtures of films, substances, compounds or compositions soluble in gastric juice and resistant to gastric juice, respectively. The same purpose of affecting the release in different sections of the gastro-intestinal tract can also be reached with appropriately produced coated tablets with a core, wherein the coating releases the active ingredient in gastric juice rapidly and the core releases the active ingredient in the environment of the small intestine. The aim of a controlled release in different sections of the gastro-intestinal tract can also be achieved by multiple coated tablets. Mixtures of pellets with differentially releasable active agent can be filled into, for example, hard gelatine capsules.

A further adjuvant employed in the production of compressed formulations like e.g. tablets, hard and soft gelatine capsules as well as coated tablets and granules are, for example, counter glue agents, lubricating agents and separating agents, dispersion agents like e.g. flame dispersion silicon dioxide, disintegrants like, e.g. various types of starch, PVP, cellulose, ester as granulating or retarding agents like, e.g. waxy and/or polymeric substances based on Eudragit™, cellulose or Cremophor™.

Furthermore medicaments formulated for peroral administration can comprise antioxidants, sweetening agents like, e.g. saccharose, xylite or mannite, taste correcting agents, flavorants, preservatives, colouring agents, buffering agents, direct compression excipients, microcrystalline cellulose, starch, hydrolysed starch (e.g. Celutab™), lactose, polyethylene glycol, polyvinylpyrrolidone, dicalcium phosphate, lubricants, fillers like, e.g. lactose or starch, binders in the form of lactose, types of starch like e.g. wheat or corn and rice starch, respectively, derivatives of cellulose like, e.g. methyl cellulose, hydroxypropyl cellulose or silica, talcum, stearate like, e.g. magnesium stearate, calcium stearate, talkum, siliconised talkum, stearic acid, cetyl alcohol or hydrogenated fats etc. A variety of substances are known to someone of skill in the art which can be added to medicaments for the formulation for peroral administration.

In a further embodiment megestrol acetate or a therapeutically acceptable salt thereof can also be formulated as an oral therapeutic system, in particular based on osmotic principles like, e.g. GIT (gastro-intestinal therapeutic system) or OROS (oral osmotic system).

Effervescent tablets or tabs are also among compressed formulations, which can be perorally administered and which are both rapidly dissolvable or suspendable in water and are rapidly drinkable instant drug formulations.

Perorally administrated formulations also include solutions e.g. drops, juices and suspension which can be produced according to methods known in the art and which can comprise - beside the already mentioned adjuvants and additives for the increase of the stability - preservatives and, if desired, flavouring agents for easier ingestion and colouring agents for better distinction as well as antioxidants and/or vitamins and sweetening agents like sugars or artificial sweeteners. This also applies to dried juices which are prepared with water prior to use. In a preferred embodiment of a formulation of the medicaments of the present invention an ingestible liquid formulation can also comprise an ion exchange resin.

In a preferred embodiment of the present invention, the megestrol acetate is selected from common megestrol acetate formulations (brand name is Megace™). So far, megestrol acetate has been commercially produced by several companies as a generic medicament. For the present study, the advanced nano-particulate oral suspension formulation Megace™ ES was used, as produced by the company PAR Pharmaceutical, Inc..

Yet another preferred embodiment of the present invention is characterised in that the medicament is applied orally. Preferably, megestrol acetate or a pharmaceutical acceptable salt thereof is applied in a dosage of between 30 mg/d and 2000 mg/d, preferably between 100 mg/d and 1600 mg/d, more preferably 300 to 800 mg/d. The active ingredient can be administered in one or several doses per day; alternatively the active ingredient can be administered in larger time intervals. Also preferably, megestrol acetate or a pharmaceutical acceptable salt thereof is applied in a dosage of between 4 and 15 mg/kg/d. The active ingredient can be administered in one or several doses per day; alternatively the active ingredient can be administered in larger time intervals.

In another important embodiment of the present invention, megestrol acetate or a pharmaceutical acceptable salt thereof is applied in combination with drugs typically used in cancer treatment, such as drugs for chemotherapy, such as alkylating drugs, such as cyclophosphamide, cytotoxic antibiotics, such as doxorubicin, antimetabolites, such as methotrexate, vinca alkaloids, such as vindesine, and drugs including platinum compounds, like carboplatin, and taxanes such as docetaxel.

In another important embodiment of the present invention, the underlying cancer is selected from cancers of the liver, pancreas, colon, prostate, lung, kidney, brain, thyroid, blood, bone, skin, pancreas, ovaries, breast, uterus, testicles, eyes, gall bladder, oesophagus, skin, and stomach.

Another particular aspect of the present invention relates to a method for treating and/or improving cachexia as a co-morbidity of cancer comprising administering an effective amount of megestrol acetate or a pharmaceutically acceptable salt thereof, optionally with appropriate adjuvants and additives, to a subject to be treated..

Preferred is a method wherein the megestrol acetate is selected from common megestrol acetate oral suspension (Megace™) and/or Megace™ ES.

More preferred is a method wherein the cancer is selected from cancers of the liver, pancreas, colon, prostate, lung, kidney, brain, thyroid, blood, bone, skin, pancreas, ovaries, breast, uterus, testicles, eyes, gall bladder, oesophagus, skin, and stomach.

The method can be performed using the medicament as described above, for example the preferred orally applied megestrol acetate or a pharmaceutical acceptable salt thereof in a dosage of between 30 mg/d and 2000 mg/d, preferably between 100 mg/d and 1600 mg/d, most preferred 300 to 800 mg/d, or in a dosage of between 4 and 15 mg/kg/d.

More preferred is a method that is characterised in that said megestrol acetate or the pharmaceutical acceptable salt thereof is applied in combination with drugs used in cancer treatment, such as drugs for chemotherapy, such as alkylating drugs, such as cyclophosphamide, cytotoxic antibiotics, such as doxorubicin, antimetabolites, such as methotrexate, vinca alkaloids, such as vindesine, and drugs including platinum compounds, like carboplatin, and taxanes such as docetaxel.

Preferably, said subject to be treated is a mammal, in particular a human suffering from cancer-cachexia.

The following example is included to demonstrate preferred embodiments of the invention for illustrative purposes only and in no way constitutes a limitation as to the practice of the invention disclosed herein. It should be appreciated by those of skill in the art that the techniques disclosed in the example that follows represent techniques discovered by the inventors to function well in the practice of the invention, and thus can be considered preferred modes for its practice. However, those of skill in the art should, in light of the present disclosure, appreciate that many changes can be made in the specific embodiments that are disclosed without departing from the spirit and scope of the invention as set out in the appended claims. For the purposes of the present invention, all references cited are incorporated herein by reference in their entireties.

Example

Animals

Male Wistar-rats (Dimed GmbH, Schonwalde, Germany) were held in an environment controlled animal facility having a constant temperature of 23 °C in a 12 hour day-night-cycle.

During the whole experiment, all rats were grouped in 1-3 animals per cage. Animals in one cage belong to the same group. The animals had free access to regular food and drinking water or drinking water with diuretic respectively.

Methods: Juvenile rats (weight approx. 20Og) were inoculated intra-peritoneally with 10⁸ AH- 130 hepatoma cells and treated with lOOmg/kg/d Megace™ ES (n=10; purchased from an international pharmacy) or placebo (n=22). Heart function (high resolution echocardiography), food intake and locomotor activity were assessed before inoculation and on day 11 of the 16-day protocol. Weight and body composition (NMR-scan) were assessed on day 0 and day 16 after sacrifice (without tumour).

Results:

Placebo-treated animals developed severe cancer cachexia, which was reduced by Megace™ ES (-54.3±2.7g vs -19.2±12.1g, p=0.0005). Megace™ ES reduced not only fat- (-4.2±3.1g vs placebo -12.00±0.64g, p=0.0017), but also muscle wasting (-11.8±6.2g vs placebo - 39.9±2.6g, pO.OOOl). Food intake and locomotor activity as indicators of quality of life were higher in higher Megace™ ES -treated rats (13.5±2.6g/d vs placebo 2.5±0.5g/d, pO.OOOland 23352±3331 counts/d vs placebo 51601±4100 counts/d, pO.OOOl). Cardiac function was improved compared to placebo animals, as shown by a better ejection fraction (73.09±6.68% vs placebo 49.65±4.87%, p=0.01), fractional shortening (45.30±5.53% vs placebo 26.54±3.63, p=0.0075) and a reduced end-systolic volume (44.17±9.63,μl vs placebo 75.17±8.78μl, p=0.042). Most importantly, Megace™ ES improved survival (p=0.029, HR: 0.37, 95% CI: 0.15-0.91).

Statistical Analysis

All results were indicated as mean value ± standard deviation. For statistical analysis the Chi- square-test was performed. All calculations were performed using Graph Pad PRISM 4.0 and SPSS 12.0 statistics program.

Conclusion: This study confirms that Megace™ ES reduces weight loss, improves quality of life and heart function in cancer-cachexia, which translated into improved survival. Hence, treatment regimes including Megace™ ES are useful in cancer-cachexia.

Claims

Par Pharmaceutical, Inc.Claims

1. Use of megestrol acetate or a pharmaceutically acceptable salt thereof, optionally with appropriate adjuvants and additives for the production of a medicament for the treatment of cachexia as a co-morbidity of cancer.

2. Use according to claim 1, characterised in that megestrol acetate is selected from megestrol acetate oral suspension (Megace™) and/or Megace™ ES.

3. Use according to claim 1 or 2, characterised in that the cancer is selected from cancers of the liver, pancreas, colon, prostate, lung, kidney, brain, thyroid, blood, bone, skin, pancreas, ovaries, breast, uterus, testicles, eyes, gall bladder, oesophagus, skin, and stomach.

4. Use according to claim 1 or 2, characterised in that the medicament is applied orally.

5. Use according to claim 1 or 2, characterised in that said megestrol acetate or the pharmaceutical acceptable salt thereof is applied in a dosage of between 30 mg/d and 2000 mg/d, preferably between 100 mg/d and 1600 mg/d, most preferred 300 to 800 mg/d.

6. Use according to claim 1 or 2, characterised in that said megestrol acetate or the pharmaceutical acceptable salt thereof is applied in a dosage of between 4 and 15 mg/kg/d.

7. Use according to claim 1 or 2 characterised in that said megestrol acetate or the pharmaceutical acceptable salt thereof is applied in combination with drugs used in cancer treatment, such as drugs for chemotherapy, such as alkylating drugs, such as cyclophosphamide, cytotoxic antibiotics, such as doxorubicin, antimetabolites, such as methotrexate, vinca alkaloids, such as vindesine, and drugs including platinum compounds, like carboplatin, and taxanes such as docetaxel.

8. A method for treating cachexia as a co-morbidity of cancer comprising administering an effective amount of megestrol acetate or a pharmaceutically acceptable salt thereof, optionally with appropriate adjuvants and additives, to a subject to be treated..

9. The method according to claim 8, characterised in that megestrol acetate is selected from common megestrol acetate oral suspension (Megace™) and/or Megace ES.

10. The method according to claim 8 or 9, characterised in that the cancer is selected from cancers of the liver, pancreas, colon, prostate, lung, kidney, brain, thyroid, blood, bone, skin, pancreas, ovaries, breast, uterus, testicles, eyes, gall bladder, oesophagus, skin, and stomach.

11. The method according to claim 8 or 9, characterised in that the medicament is applied orally.

12. The method according to claim 8 or 9, characterised in that the megestrol acetate or a pharmaceutical acceptable salt thereof is applied in a dosage of between 30 mg/d and 2000 mg/d, preferably between 100 mg/d and 1600 mg/d, most preferred 300 to 800 mg/d.

13. The method according to claim 8 or 9, characterised in that the megestrol acetate or a pharmaceutical acceptable salt thereof is applied in a dosage of between 4 and 15 mg/kg/d.

14. The method according to claim 8 or 9, characterised in that said megestrol acetate or the pharmaceutical acceptable salt thereof is applied in combination with drugs used in cancer treatment, such as drugs for chemotherapy, such as alkylating drugs, such as cyclophosphamide, cytotoxic antibiotics, such as doxorubicin, antimetabolites, such as methotrexate, vinca alkaloids, such as vindesine, and drugs including platinum compounds, like carboplatin, and taxanes such as docetaxel.

15. The method according to claim 8 or 9, wherein said subject to be treated is a mammal, in particular a human.