Randomized clinical trial of adenosine 5'-triphosphate in patients with advanced non-small-cell lung cancer
BACKGROUND: Extracellular adenosine 5'-triphosphate (ATP) is involved in the regulation of a variety of biologic processes, including neurotransmission, muscle contraction, and liver glucose metabolism, via purinergic receptors. In nonrandomized studies involving patients with different tumor types including non-small-cell lung cancer (NSCLC), ATP infusion appeared to inhibit loss of weight and deterioration of quality of life (QOL) and performance status. We conducted a randomized clinical trial to evaluate the effects of ATP in patients with advanced NSCLC (stage IIIB or IV). METHODS: Fifty-eight patients were randomly assigned to receive either 10 intravenous 30-hour ATP infusions, with the infusions given at 2- to 4-week intervals, or no ATP. Outcome parameters were assessed every 4 weeks until 28 weeks. Between-group differences were tested for statistical significance by use of repeated-measures analysis, and reported P values are two-sided. RESULTS: Twenty-eight patients were allocated to receive ATP treatment and 30 received no ATP. Mean weight changes per 4-week period were -1.0 kg (95% confidence interval [CI] = -1.5 to -0.5) in the control group and 0.2 kg (95% CI = -0.2 to +0.6) in the ATP group (P =.002). Serum albumin concentration declined by -1.2 g/L (95% CI= -2.0 to -0.4) per 4 weeks in the control group but remained stable (0.0 g/L; 95% CI = -0.3 to +0.3) in the ATP group (P =.006). Elbow flexor muscle strength declined by -5.5% (95% CI = -9.6% to -1. 4%) per 4 weeks in the control group but remained stable (0.0%; 95% CI= -1.4% to +1.4%) in the ATP group (P =.01). A similar pattern was observed for knee extensor muscles (P =.02). The effects of ATP on body weight, muscle strength, and albumin concentration were especially marked in cachectic patients (P =.0002, P =.0001, and P =. 0001, respectively, for ATP versus no ATP). QOL score changes per 4-week period in the ATP group showed overall less deterioration than in the control group-physical scores (-0.2% versus -2.4%; P =. 0002); functional scores (+0.4% versus -5.5%; P =.02); psychologic scores (-0.7% versus -2.4%; P =.11); overall QOL score (+0.1% versus -3.5%; P =.0001). CONCLUSIONS: This randomized trial demonstrates that ATP has beneficial effects on weight, muscle strength, and QOL in patients with advanced NSCLC.
|Keywords||Adenosine Triphosphate/*therapeutic use, Aged, Body Weight, Cachexia/*drug therapy/etiology/prevention & control, Carcinoma, Non-Small-Cell Lung/*complications, Female, Humans, Lung Neoplasms/*complications, Male, Middle aged, Muscle Contraction/drug effects, Muscle Weakness/drug therapy/etiology, Palliative Care/*methods, Quality of Life, Research Support, Non-U.S. Gov't, Serum Albumin/metabolism, Treatment Outcome, Wasting Syndrome/*drug therapy/etiology/prevention & control|
Agteresch, H.J., Dagnelie, P.C., van der Gaast, A., Stijnen, Th., & Wilson, J.H.P.. (2000). Randomized clinical trial of adenosine 5'-triphosphate in patients with advanced non-small-cell lung cancer. National Cancer Institute. Journal (Print). Retrieved from http://hdl.handle.net/1765/9253