Cancer cachexia: rationale for the MENAC (Multimodal—Exercise, Nutrition and Anti-inflammatory medication for Cachexia) trial

@article{Solheim2018CancerCR,
  title={Cancer cachexia: rationale for the MENAC (Multimodal—Exercise, Nutrition and Anti-inflammatory medication for Cachexia) trial},
  author={Tora Skeidsvoll Solheim and Barry J A Laird and Trude Rakel Balstad and Asta Bye and G. B. Stene and Vickie E. Baracos and Florian Strasser and Gareth O Griffiths and Matthew Maddocks and Marie Fallon and Stein Kaasa and Kenneth C. H. Fearon},
  journal={BMJ Supportive \& Palliative Care},
  year={2018},
  volume={8},
  pages={258 - 265}
}
Cancer cachexia is a multifactorial syndrome characterised by an ongoing loss of skeletal muscle mass that cannot be fully reversed by conventional nutritional support alone. Cachexia has a high prevalence in cancer and a major impact on patient physical function, morbidity and mortality. Despite the consequences of cachexia, there is no licensed treatment for cachexia and no accepted standard of care. It has been argued that the multifactorial genesis of cachexia lends itself to therapeutic… 
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References

SHOWING 1-10 OF 71 REFERENCES
Are there any benefits of exercise training in cancer cachexia?
TLDR
This editorial is aimed at stimulating the debate on the suitability of including exercise training in a multi-functional approach against cachexia taking into consideration both limitations and advantages.
Cancer cachexia and targeting chronic inflammation: a unified approach to cancer treatment and palliative/supportive care.
TLDR
To establish the value of early nutritional/metabolic intervention, clinical trials are needed that combine measures that combat cachexia and inflammation with first-line chemotherapy in patients who present with weight loss, fatigue, and deteriorating function.
Non-steroidal anti-inflammatory treatment in cancer cachexia: A systematic literature review
TLDR
Evidence is too frail to recommend NSAID for cachexia outside clinical trials, but there is some evidence on effect on physical performance, self-reported quality of life and inflammatory parameters.
Evidence base for multimodal therapy in cachexia
  • T. Solheim, B. Laird
  • Medicine, Psychology
    Current opinion in supportive and palliative care
  • 2012
TLDR
The effectiveness of any drug intervention for cancer cachexia probably will only be maximized if incorporated into multimodal treatment, and cachexia treatment trials should also aim to include patients at an early phase in their cachexia trajectory and use validated outcome measures.
A randomized phase II feasibility trial of a multimodal intervention for the management of cachexia in lung and pancreatic cancer
TLDR
The feasibility and safety of a multimodal intervention (n‐3 polyunsaturated fatty acid nutritional supplements, exercise, and anti‐inflammatory medication: celecoxib) for cancer cachexia in patients with incurable lung or pancreatic cancer, undergoing chemotherapy are examined.
Immunological and hormonal effects of exercise: implications for cancer cachexia
TLDR
There is limited scope to extrapolate the findings of recent studies on therapeutic exercise for cancer cachexia to patients with cancer, who are more likely to have advanced disease, higher levels of systemic inflammation, and greater degrees of metabolic dysfunction.
Exercise for cancer cachexia in adults.
TLDR
The effects of exercise, compared to usual care or no treatment, on lean body mass, the main biomarker of cachexia, in adults with cancer is determined.
Clinical outcomes and contributors to weight loss in a cancer cachexia clinic.
TLDR
A combination of simple pharmacological and nonpharmacological interventions improved appetite significantly, and increased weight in one third of patients who were able to return for follow-up.
...
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