# Test protein and resistance training during immunotherapy

Source: https://onco.cc/ideas/idea-bio2-protein-plus-training-during-io/  
OnCo record `idea-bio2-protein-plus-training-during-io` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Muscle is an immune organ as well as a movement organ. Building it during immunotherapy might improve how well the treatment works, not just how patients feel.

## Summary

Muscle secretes myokines including interleukin-15 and irisin that affect immune cell function, and low muscle mass is associated with poorer checkpoint inhibitor outcomes in several retrospective series. Whether that association is causal or simply reflects disease burden is unknown, and a randomised exercise and protein intervention during checkpoint therapy would answer it while also improving function.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Supervised resistance training with protein supplementation during checkpoint blockade improves progression-free survival or response rate compared with usual care, mediated by measurable changes in circulating immune cell phenotype.
- Rationale: Exercise increases natural killer cell mobilisation and alters myeloid phenotype in humans, and mouse studies show exercise-dependent improvements in tumour immune control. The intervention has no toxicity and independent quality-of-life benefit, so the trial is low-risk.
- Proposed test: A randomised trial in patients starting checkpoint blockade with response and immune profiling co-primary endpoints, powered pragmatically and embedded in routine care.
- Maturity: speculative
- Actor: research

## Sources

- Bottleneck evidence (Cachexia, toxicity and the limits of the patient): Fearon et al., Definition and classification of cancer cachexia (Lancet Oncology 2011): https://doi.org/10.1016/S1470-2045(10)70218-7

## Connected records

- ideas: [Structured exercise prescribed like a drug in all curative-intent cancer care](https://onco.cc/ideas/idea-exercise-as-adjuvant/)
- cancers: [Melanoma](https://onco.cc/cancers/melanoma/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Renal cell carcinoma](https://onco.cc/cancers/rcc/)
- technologies: [Exercise & lifestyle oncology](https://onco.cc/technologies/exercise-oncology/), [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/)
- bottlenecks: [Cachexia, toxicity and the limits of the patient](https://onco.cc/bottlenecks/b-cachexia-supportive/), [Cold tumours and the immunosuppressive microenvironment](https://onco.cc/bottlenecks/b-tme-immunosuppression/), [No one can predict who responds to immunotherapy](https://onco.cc/bottlenecks/b-immunotherapy-response/)
- key papers: [Definition and classification of cancer cachexia: an international consensus](https://onco.cc/key-papers/paper-fearon-lancet-oncol/)

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