Methylphenidate and Cancer Fatigue

One of the most common symptoms that cancer patients experience is fatigue. Fatigue is also a common side effect of cancer chemotherapy. In one of our studies of breast cancer patients, 36 percent experienced fatigue as the principle side effect of the chemotherapy combination. Furthermore, the emotional stress associated with a cancer diagnosis can result in varying degrees of depression, also characterized by fatigue.

Studies conducted in recent years have established that cancer patients often benefit from the use of antidepressants. These can improve energy and counteract insomnia, while addressing the emotional challenges that many patients confront. While there are numerous forms of antidepressants, most function by enhancing the effects of neurotransmitters within the brain. The modern selective serotonin re-uptake inhibitors (SSRIs) are widely used in cancer patients.

Older classes of antidepressants work as direct CNS stimulants. The amphetamines and related methylphenidate are CNS stimulants. Studies conducted in the last decade establish that methylphenidate can be safely administered to cancer patients to counteract fatigue and depression. Indeed, methylphenidate is one of the most rapidly acting antidepressants and has been used in the psychiatric literature for many years. When used appropriately the drug is well tolerated. Interestingly, it does not result in weight loss, despite its CNS stimulant effects.

While these drugs can be important adjuncts to cancer therapy, they can also be extremely toxic with such serious side effects as: paranoia, anxiety, insomnia, weight loss, hypertension, cardiac stimulation and convulsions. It is therefore extremely important that these classes of drugs be administered judiciously under the direct supervision of a trained oncologist or psychiatrist.

About Dr. Robert A. Nagourney
Dr. Nagourney received his undergraduate degree in chemistry from Boston University and his doctor of medicine at McGill University in Montreal, where he was a University Scholar. After a residency in internal medicine at the University of California, Irvine, he went on to complete fellowship training in medical oncology at Georgetown University, as well as in hematology at the Scripps Institute in La Jolla. During his fellowship at Georgetown University, Dr. Nagourney confronted aggressive malignancies for which the standard therapies remained mostly ineffective. No matter what he did, all of his patients died. While he found this “standard of care” to be unacceptable, it inspired him to return to the laboratory where he eventually developed “personalized cancer therapy.” In 1986, Dr. Nagourney, along with colleague Larry Weisenthal, MD, PhD, received a Phase I grant from a federally funded program and launched Oncotech, Inc. They began conducting experiments to prove that human tumors resistant to chemotherapeutics could be re-sensitized by pre-incubation with calcium channel blockers, glutathione depletors and protein kinase C inhibitors. The original research was a success. Oncotech grew with financial backing from investors who ultimately changed the direction of the company’s research. The changes proved untenable to Dr. Nagourney and in 1991, he left the company he co-founded. He then returned to the laboratory, and developed the Ex-vivo Analysis - Programmed Cell Death ® (EVA-PCD) test to identify the treatments that would induce programmed cell death, or “apoptosis.” He soon took a position as Director of Experimental Therapeutics at the Cancer Institute of Long Beach Memorial Medical Center. His primary research project during this time was chronic lymphocytic leukemia. He remained in this position until the basic research program funding was cut, at which time he founded Rational Therapeutics in 1995. It is here where the EVA-PCD test is used to identity the drug, combinations of drugs or targeted therapies that will kill a patient's tumor - thus providing patients with truly personalized cancer treatment plans. With the desire to change how cancer care is delivered, he became Medical Director of the Todd Cancer Institute at Long Beach Memorial in 2003. In 2008, he returned to Rational Therapeutics full time to rededicate his time and expertise to expand the research opportunities available through the laboratory. He is a frequently invited lecturer for numerous professional organizations and universities, and has served as a reviewer and on the editorial boards of several journals including Clinical Cancer Research, British Journal of Cancer, Gynecologic Oncology, Cancer Research and the Journal of Medicinal Food.

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