Auckland’s Cancer Cachexia evaluating Resistance Training (ACCeRT) main study results

Background Cancer cachexia is a condition often seen at diagnosis, throughout anticancer treatments and in end stage non-small-cell lung cancer (NSCLC) patients.
Methods Participants with late stage NSCLC and cachexia (defined as ≥5% weight loss within 12 months) were randomly assigned 1:2 to 2·09 g of eicosapentaenoic acid (EPA) and 300 mg cyclo-oxygenase-2 (COX-2) inhibitor celecoxib orally once daily versus same dosing of EPA, celecoxib, plus two sessions per week of progressive resistance training (PRT) and 20 g oral essential amino acids (EAA) high in leucine in a split dose over three days, post each session. Primary endpoint was the acceptability of the above multi-targeted approach. Main secondary endpoints included change in body weight and fat-free mass (FFM), by bioelectric impedance analysis (BIA) and total quadriceps muscle volume by Magnetic Resonance Imaging (MRI) over 20 weeks.
Results Sixty-nine patients were screened resulting in 20 patients being enrolled. Acceptability scored high, with 4·5/5 (Arm A) and 5/5 (Arm B) for EPA and 5/5 for celecoxib within both Arms, and 4·8/5 for PRT sessions and 4·5/5 for EAA within Arm B, all at week 20. Results showed a net gain in BIA FFM of +1·3 kg, n=2 (Arm A), compared with +0·7 kg, n=7 (Arm B) at week 12, and -1·5 kg, n=2 (Arm A), compared with ˗1·7 kg, n=4 (Arm B) at week 20. Trends in efficacy in terms of improvement and/or stability in cachexia markers were seen within MRI muscle volume, albumin and C-reactive protein levels within both Arms. There were no exercise-related adverse events, with one possible related adverse event of asymptomatic atrial fibrillation in one participant within Arm A.
Conclusion NSCLC cachectic patients are willing to be enrolled onto a multi-targeted treatment regimen and may benefit from cachexia symptom management even during the late/refractory stage.