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Randomized clinical trial of adenosine 5'-triphosphate in patients with advanced non-small-cell lung cancer
H J Agteresch1, P C Dagnelie, A van der Gaast
1Department of Internal Medicine, Erasmus University Medical Center Rotterdam, The Netherlands.
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.
Insights
Adenosine triphosphate (ATP) infusions improved weight, muscle strength, and quality of life in patients with advanced non-small-cell lung cancer (NSCLC). This randomized trial suggests ATP may help manage cancer-related symptoms.
Area of Science:
- Biochemistry
- Oncology
- Clinical Trials
Background:
- Extracellular adenosine triphosphate (ATP) regulates vital biologic processes.
- Previous studies suggested ATP may inhibit weight loss and improve quality of life (QOL) in cancer patients.
- Advanced non-small-cell lung cancer (NSCLC) patients often experience cachexia and QOL decline.
Purpose of the Study:
- To evaluate the efficacy of intravenous adenosine triphosphate (ATP) infusions in patients with advanced non-small-cell lung cancer (NSCLC).
- To assess ATP's impact on body weight, muscle strength, serum albumin, and quality of life (QOL).
Main Methods:
- A randomized clinical trial involving 58 patients with advanced NSCLC (stage IIIB or IV).
- Patients received either 10 intravenous ATP infusions over 30 hours at 2- to 4-week intervals or no ATP.
- Outcome parameters including weight, muscle strength, albumin, and QOL were assessed every 4 weeks for 28 weeks.
Main Results:
- ATP treatment group showed significant improvements in weight (0.2 kg vs -1.0 kg) and stable serum albumin levels compared to the control group.
- Muscle strength (elbow flexors and knee extensors) remained stable in the ATP group, while declining in the control group.
- Patients receiving ATP experienced less deterioration in physical, functional, and overall QOL scores compared to controls, particularly cachectic patients.
Conclusions:
- Adenosine triphosphate (ATP) demonstrates beneficial effects on weight, muscle strength, and quality of life in advanced NSCLC patients.
- ATP may be a viable supportive therapy to mitigate cancer-related symptoms and improve outcomes in NSCLC.
- Further research into ATP's role in cancer supportive care is warranted.