Abstract
BackgroundCancer cachexia is a syndrome of progressive weight loss. Non-small cell lung cancer patients experience a high incidence of cachexia of 61%. Research into methods to combat cancer cachexia in various tumour sites has recently progressed to the combination of agents.The combination of the anti-cachectic agent Eicosapentaenoic acid (EPA) and the cyclo-oxygenase-2 (COX-2) inhibitor celecoxib has been tested in a small study with some benefit. The use of progressive resistance training (PRT) followed by the oral ingestion of essential amino acids (EAA), have shown to be anabolic on skeletal muscle and acceptable in older adults and other cancer groups.The aim of this feasibility study is to evaluate whether a multi-targeted approach encompassing a resistance training and nutritional supplementation element is acceptable for lung cancer patients experiencing cancer cachexia.Methods/DesignAuckland's Cancer Cachexia evaluating Resistance Training (ACCeRT) is an open label, prospective, randomised controlled feasibility study with two parallel arms. All patients will be treated with EPA and the COX-2 inhibitor celecoxib on an outpatient basis at the study site. In the experimental group patients will participate in PRT twice a week, followed by the ingestion of essential amino acids high in leucine. A total of 21 patients are planned to be enrolled. Patients will be randomised using 1:2 ratio with 7 patients enrolled into the control arm, and 14 patients into the treatment arm. The primary endpoint is the acceptability of the above multi-targeted approach, determined by an acceptability questionnaire.DiscussionTo our knowledge ACCeRT offers for the first time the opportunity to investigate the effect of stimulating the anabolic skeletal muscle pathway with the use of PRT along with EAA alongside the combination of EPA and celecoxib in this population.Trial registrationNetherlands Trial Register (NTR): ACTRN12611000870954
Highlights
Cancer cachexia is a syndrome of progressive weight loss
Cancer cachexia involves relatively similar losses of adipose and muscle tissue which differs from simple starvation or conditions such as anorexia nervosa, where the majority of weight loss is from adipose rather than muscle tissue [2,4,5,6]
This phase II study reported that when progressive resistance training (PRT) was performed an average 2.5 times a week for 12 weeks, significant increases in total body skeletal muscle mass occurred with an adjusted total lean mass of 45.0 ± 0.3 kg in the training group and by 43.8 ± 0.3 in the control group (P= 0.005)
Summary
Non-small cell lung cancer patients experience a high incidence of cachexia of 61%. The use of progressive resistance training (PRT) followed by the oral ingestion of essential amino acids (EAA), have shown to be anabolic on skeletal muscle and acceptable in older adults and other cancer groups. The aim of this feasibility study is to evaluate whether a multi-targeted approach encompassing a resistance training and nutritional supplementation element is acceptable for lung cancer patients experiencing cancer cachexia. Cancer cachexia is a syndrome of progressive weight loss, metabolic alterations, fatigue and persistent reduction of body cell mass in response to a malignant tumour in the presence or absence of anorexia [1,2,3]. It is estimated that cachexia is present in up to 80% of cancer patients at death, and the main cause of death in 20% of all cancer patients [6,9]
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