1611TiP - A novel multimodal treatment strategy for cancer cachexia; rationale and motivation for the MENAC (Multimodal – Exercise, Nutrition and Anti-inflam...

Date 10 September 2017
Event ESMO 2017 Congress
Session Poster display session
Topics Palliative Care
Supportive and Palliative Care
Presenter Stein Kaasa
Citation Annals of Oncology (2017) 28 (suppl_5): v543-v567. 10.1093/annonc/mdx388
Authors S. Kaasa1, B. Laird2, T. Balstad3, G. Stene4, V. Baracos5, A. Bye6, F. Strasser7, M. Fallon8, K. Fearon9
  • 1Department Of Cancer Treatment, Oslo University Hospital, 0424 - Oslo/NO
  • 2Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh/GB
  • 3European Palliative Care Research Centre (prc), Department Of Cancer Research And Molecular Medicine, Faculty Of Medicine, Norwegian University of Science and Technology, Trondheim/NO
  • 4Department Of Neuroscience, Faculty Of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim/NO
  • 5Department Of Oncology, Division Of Palliative Care Medicine, Department of Oncology, Division of Palliative Care Medicine, Alberta/CA
  • 6Oslo University Hospital/ Oslo And Akershus University College Of Applied Sciences, Regional Advisory Unit for Palliative Care, Department of Oncology/ Dept of Nursing and Health Promotion, Oslo/NO
  • 7Department Internal Medicine & Centre For Palliative Care, Kantonsspital St. Gallen, 9007 - St. Gallen/CH
  • 8Edinburgh Cancer Research Centre, University of Edinburgh, EH4 2XR - Edinburgh/GB
  • 9Department Of Surgery,, Royal Infirmary, Edinburgh/GB



Cancer cachexia is a multifactorial syndrome characterized by an on-going 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 and no standard of care. It has been argued that the multifactorial genesis of cachexia lends itself well to therapeutic targeting through a multimodal treatment. Following a successful phase II trial, a phase III trial is underway.

Trial design

MENAC is a multicentre, open, randomized phase III study comparing multimodal intervention and standard cancer care versus standard cancer care alone. Patients treated for incurable lung and pancreatic cancer will be allocated randomly to receive the multimodal intervention, either immediately, or after endpoint at six weeks. The intervention is based on evidence to date and consists of Non-steroidal Anti-inflammatory Drugs (NSAID) and an EPA containing oral nutrition supplement to reduce inflammation, a physical exercise progamme consisting of both resistance and aerobic exercises to increase anabolism, as well as dietary counselling aiming to promote energy and protein balance. The overall aim is to reduce weight loss, improve food intake and maintain physical function by establish basic supportive care for cachexia. From a patient perspective, a short-term effect will be to improve physical and psychological function and reduce symptom burden. Change in body weight is primary endpoint. Secondary endpoints are change in muscle mass (CT technique) and physical activity (ActivPAL activity meter). There are several exploratory endpoints. The trial is ongoing and patients are recruited from several sites in Europa and Canada, we aim for 240 patients. If positive, the results will be practice changing for supportive treatment of patients with cancer.

Clinical trial identification


Legal entity responsible for the study

NTNU through PRC is coordinating the running of the trial.


The European Union through the European Clinical Research Infrastructures Network (ECRIN) Canadian Institute for Health Research Marie Curie and Raising Tide foundation Norwegian Cancer union The Omega 3 capsules are recieved free of charge from Pronova BioPharma Norge AS. The oral nutritional supplements are received free of charge from Abbott Nutrition


All authors have declared no conflicts of interest.