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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105 Citations
Highly Influential Citations
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Background Citations
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Methods Citations
4
Results Citations
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105 Citations

Effect of multimodal intervention care on cachexia in patients with advanced cancer compared to conventional management (MIRACLE): an open-label, parallel, randomized, phase 2 trial
TLDR
A randomized trial to investigate the efficacy and safety of a multimodal intervention compared to the best supportive care for patients who received palliative chemotherapy, and considering the complex mechanisms of cachexia, the effect of MIC rather than a single specific drug is more promising.
Diet-related interventions for cancer-associated cachexia
TLDR
Whether different forms of multimodal therapy—combinations of cancer treatment, dietary regimens, anti-inflammatory therapy, and physical therapy—are effective methods to improve outcomes in advanced cancer patients with cachexia is examined.
Nutraceuticals and Exercise against Muscle Wasting during Cancer Cachexia
TLDR
This review focuses on the current state of the field on the role of inflammation and OS in the pathogenesis of muscle atrophy during CC, and how nutraceuticals and physical activity may act synergistically to limit muscle wasting and dysfunction.
Combination therapy in cachexia.
TLDR
Despite the variations in therapy composition, most multimodal regimens share a common purpose in simultaneously modulating the major mechanisms causing cachexia, identifying patients early in the illness trajectory, and including supportive care measures such as symptom management, exercise, and nutritional counseling/supplementation.
Impact of Cancer Cachexia on Cardiac and Skeletal Muscle: Role of Exercise Training
TLDR
The aim of this review is to understand how cachexia manifests and whether physical exercise has any role in trying to prevent or reverse this syndrome in cancer patients and to evaluate the current clinical evidence of the use of physical exercise in patients with cachexia.
Cancer-Related Cachexia: The Vicious Circle between Inflammatory Cytokines, Skeletal Muscle, Lipid Metabolism and the Possible Role of Physical Training
TLDR
The evidence for the relationship between inflammatory cytokines, skeletal muscle, and fat metabolism and the potential role of exercise training in breaking the vicious circle of this impaired tissue cross-talk is presented.
Dietetic assessment and intervention in lung cancer.
TLDR
There is a paucity of data on dietetic intervention, but it is potentially quick, inexpensive and patient specific, using a holistic approach to aid patients who are malnourished or at risk of malnutrition.
Cancer Cachexia and Related Metabolic Dysfunction
TLDR
A multimodal intervention, including pharmacological agents, nutritional support, and physical exercise, may be a reasonable approach for future studies to better understand and prevent the wasting of body compartments in patients with cancer cachexia.
What are the criteria for response to cachexia treatment?
TLDR
Improvement in physical function may be best measured by patient reported outcomes, and ongoing and future clinical trials in cancer cachexia should assess all 3 domains, which will improve the understanding of this syndrome and ultimately lead to better treatment options.
Pharmacological management of cachexia in adult cancer patients: a systematic review of clinical trials
TLDR
Anamorelin as a single agent shows promising results in improving cachexia related weight loss among cancer patients and use of combination agents provide evidence for targeting multiple pathways underlying cachexia mechanism to achieve maximum benefit.
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