Modafinil improves severe cancer-related fatigue

A study announced at the 44th annual ASCO meeting found that modafinil (Provigil), a ‘eugeroic agent', is useful in treating severe cancer-related fatigue.

Fatigue is one of the most common side effects of cancer and its treatment, and there are very few effective ways to manage it. Studies have shown that 80 to 85 percent of people receiving chemotherapy report fatigue.

Eugeroic agents are stimulants that improve wakefulness without interfering with sleep or causing addiction because they clear from the body within about 12 hours. Modafinil is currently approved by the U.S. Food and Drug Administration for the treatment of narcolepsy, sleep apnea and other sleep-related problems.

This randomised study from the University of Roichester, USA, included 642 cancer patients who were undergoing chemotherapy for a variety of cancer types. There were 320 patients in the modafinil group and 322 in the placebo group. Patient fatigue, sleepiness and depression were evaluated by survey and were assessed twice - first at the time the trial started (during the second cycle of chemotherapy), and again during the fourth cycle of chemotherapy. Comparing fatigue, sleepiness and depression at the two time points, investigators found that patients who had the most severe fatigue at the beginning of the study demonstrated significant improvement from taking the drug, compared to those in the placebo group. Patients with mild or moderate fatigue did not see the same improvements. The drug also had a significant beneficial effect on sleepiness but had no effect on depression.