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Cancer cachexia: rationale for the MENAC (Multimodal—Exercise, Nutrition and Anti-inflammatory medication for Cachexia) trial
  1. Tora S Solheim1,2,
  2. Barry J A Laird3,
  3. Trude R Balstad1,2,
  4. Asta Bye4,5,
  5. Guro Stene1,2,6,
  6. Vickie Baracos7,
  7. Florian Strasser8,
  8. Gareth Griffiths9,
  9. Matthew Maddocks10,
  10. Marie Fallon3,
  11. Stein Kaasa1,2,11 and
  12. Kenneth Fearon3,12
  1. 1 European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
  2. 2 Cancer Clinic, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
  3. 3 University of Edinburgh, Edinburgh, UK
  4. 4 Department of Oncology, Regional Advisory Unit in Palliative Care, University Hospital, Oslo, Norway
  5. 5 Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
  6. 6 Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
  7. 7 Department of Oncology, Division of Palliative Care Medicine, University of Alberta, Edmonton, Alberta, Canada
  8. 8 Oncological Palliative Medicine, Clinic Medical Oncology and Haematology, Department of Internal Medicine, CantonalHospital, StGallen, Switzerland
  9. 9 Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
  10. 10 King’s College London, Cicely Saunders Institute, London, UK
  11. 11 Oslo University Hospital and University of Oslo, Oslo, Norway
  12. 12 Department of Surgery, Royal Infirmary, Edinburgh, UK
  1. Correspondence to Dr Barry J A Laird, University of Edinburgh, Edinburgh EH8 9YL, UK; barry.laird{at}
  • Kenneth Fearon is deceased.


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 targeting through a multimodal treatment. Following a successful phase II trial, a phase III randomised controlled trial of a multimodal cachexia intervention is under way. Termed the MENAC trial (Multimodal—Exercise, Nutrition and Anti-inflammatory medication for Cachexia), this intervention is based on evidence to date and consists of non-steroidal anti-inflammatory drugs and eicosapentaenoic acid to reduce inflammation, a physical exercise programme using resistance and aerobic training to increase anabolism, as well as dietary counselling and oral nutritional supplements to promote energy and protein balance. Herein we describe the development of this trial.

Trial registration number NCT02330926.

  • cachexia
  • trial

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  • 30 TSS and BJAL are joint first authors.

  • 32 SK and KF are joint senior authors.

  • Contributors TS, BL, SK and KF led the manuscript writing. KF conceptualised the MENAC trial. TB, AB, GS, VB, MM, MF, FS and GG had significant input in manuscript preparation. All authors approved the submitted manuscript.

  • Funding UK: Marie Curie, Pancreatic Cancer UK and the Rising Tide Foundation funded the MENAC trial.

  • Competing interests None declared.

  • Ethics approval Ethical approval was not required for this article; however, ethical and regulatory approval has been given for the MENAC trial.

  • Provenance and peer review Not commissioned; externally peer reviewed.