UNIVERSITY OF EDINBURGH: The MENAC Trial "A randomised, open-label trial of a Multimodal Intervention (Multimodal = Exercise, Nutrition and Anti-inflammatory Medication) versus standard care in cancer patients with Cachexia"

Year of Grant: 2015

Location: United Kingdom


Cancer cachexia is a multi-factorial syndrome characterized by weight loss, muscle wasting, anorexia and fatigue, and is associated with reduced treatment tolerance, quality of life and shortened survival. For patients and their families, cachexia is a severe, unrelieved cause of suffering. There is neither a licensed cachexia treatment nor a standard of care. 


Cachexia is present in more than 50% of patients with advanced pancreatic or lung cancer at the time of diagnosis. In these types of cancer, the average survival duration for patients is less than one year. The rapid development of cachexia means that the ability to deliver appropriate anti-cancer treatment is significantly impaired.


The pathophysiology of cachexia is multi-factorial. It consists of a negative protein and energy balance driven by a variable combination of reduced food intake, inflammation and abnormal metabolism. There is strong evidence that cachexia pathophysiology can be understood in terms of its component parts. Specific elements (muscle wasting, reduced physical activity, negative energy and protein balance, systemic inflammation) lend themselves to therapeutic reversal through a multimodal approach.


It is agreed that the best way to treat cancer cachexia is to prevent it, as once cachexia is firmly established, there is limited reversibility. The treatment of cancer cachexia should start as early as possible, however effective treatment has been very limited. Although the multifactorial pathophysiology of cachexia is understood in general, only single or bi-modal therapeutic interventions have been examined with modest success.


This multinational, phase III clinical trial (N=180) seeks to investigate the hypothesis that a multimodal intervention delivered during chemotherapy in advanced lung or pancreatic cancer is effective in preventing and/or delaying cancer cachexia, and as a consequence, will improve weight, food intake, physical function and quality of life.


If the trial is positive, the proposed cachexia intervention can be immediately adopted into current practice and can be  easily implemented across the healthcare system. It could become the new standard of care to improve the quality of life for cancer patients. Treating cachexia may also potentially support a more effective cancer treatment, such as chemotherapy.