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Supportive Oncology Cancer Cachexia role in regulating skeletal muscle mass and function. Genetic evidence demonstrates this conclusively as deletion or knockout of the myostatin gene produces mice with a phenotype exhibiting a dramatic increase in the size and number of skeletal muscle fibres. 76 Rodent models of cancer with cachexia clearly demonstrate raised levels of myostatin. 77 Pharmacological blockade of the myostatin/activin-ActRIIB signalling pathway not only prevented further muscle wasting, but also reversed pre-existent loss of skeletal muscle. NCT 01505530 is a multicentre, randomised, double-blind, placebo-controlled trial in participants with locally advanced/inoperable or metastatic pancreatic cancer, and will investigate two doses of a myostatin monoclonal antibody (LY2495655) in combination with chemotherapy. Its primary endpoint is survival however lean body mass and patient performance levels are secondary outcomes. 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