Beneficial Effects of Adenosine Triphosphate on Nutritional Status in Advanced Lung Cancer Patients: A Randomized Clinical Trial

Abstract

Background: In a randomized clinical trial in patients with advanced non–small‐cell lung cancer (NSCLC), infusion with adenosine 5′‐triphosphate (ATP) inhibited loss of body weight and quality of life. In the present article, the effects of ATP on body composition, energy intake, and energy expenditure as secondary outcome measures in the same patients are reported. Methods: Patients with NSCLC, stage IIIB or IV, were randomized to receive either 10 IV, 30‐hour ATP infusions every 2 to 4 weeks, or no ATP. Fat mass (FM), fat‐free mass (FFM), and arm muscle area were assessed at 4‐week intervals for 28 weeks. Food intake, body cell mass (BCM), and resting energy expenditure (REE) were assessed at 8‐week intervals for 16 weeks. Between‐group differences were tested for statistical significance by repeated‐measures analysis of covariance. Results: Fifty‐eight patients were randomized (28 ATP, 30 control). No change in body composition over the 28‐week follow‐up period was found in the ATP group, whereas per 4 weeks, the control group lost 0.6 kg of FM (p = .004), 0.5 kg of FFM (p = .02), 1.8% of arm muscle area (p = .02), and 0.6% of BCM per kilogram body weight (p = .054) and decreased 568 kJ/day in energy intake (p = .0001). Appetite also remained stable in the ATP group but decreased significantly in the control group (p = .0004). No significant differences in REE between the ATP and control groups were observed. Conclusions: The inhibition of weight loss by ATP infusions in patients with advanced NSCLC is attributed to counteracting the loss of both metabolically active and inactive tissues. These effects are partly ascribed to maintenance of energy intake.