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ABSTRACT Introduction Cachexia is a complex multi-factorial syndrome characterized by anorexia, inflammation, body, and skeletal muscle wasting. Early diagnosis and intervention via a multimodal approach combining nutritional counseling, exercise, and pharmacological agents is advisable. However, no effective treatment options are currently available in the clinical setting. Areas covered The present work is a review of emerging treatment options for cancer cachexia, including mainly, but not only, pharmacological approaches. The main interest is on drugs currently investigated in clinical trials; however, promising pre-clinical options are presented as well. Data were collected using PubMed and ClinicalTrials.gov databases, including studies of the last 20 years and active clinical trials. Expert opinion The lack of effective therapeutic approaches against cachexia results from several issues, among which a reduced number of studies focused on new drugs. Furthermore, the translation of pre-clinical results in the clinical practice is a hard mission, and it must be considered whether drugs target cachexia as a consequence of acting directly on the tumor. Indeed, dissecting antineoplastics from direct anti-cachexia effects is needed to elucidate the mechanisms of action of specific drugs. This is necessary for their inclusion into multimodal approaches, which nowadays are considered the best way to tackle cachexia.