Abstract
BackgroundThe clinical consequences of pancreatic exocrine insufficiency and its treatment in advanced pancreatic ductal adenocarcinoma (PDAC) are poorly investigated. This retrospective study aims at investigating the pancreatic enzyme replacement therapy (PERT) use and its impact on survival and maldigestion-related symptoms in advanced PDAC patients undergoing chemotherapy.MethodsA retrospective analysis was conducted on advanced PDAC patients, treated with first-line gemcitabine plus nab-paclitaxel at two academic institutions (March 2015-October 2018). Data were correlated with overall survival (OS) using Cox regression model. Kaplan-Meier curves were compared using Log-Rank test.ResultsData from 110 patients were gathered. PERT was administered in 55 patients (50%). No significant differences in baseline characteristics with those who did not receive PERT were found. Median OS for the entire group was 12 months (95% CI 9-15). At multivariate analysis, previous surgical resection of the primary tumor, (HR 2.67, p=0.11), weight gain after 3 months (HR 1.68, p=0.07) and PERT (HR 2.85, p ≤ 0.001) were independent predictors of OS. Patients who received PERT reported an improvement of maldigestion-related symptoms at 3 months more frequently than patients who did not (85.2% vs 14.8%, p ≤ 0.0001).ConclusionPERT is associated with significantly prolonged survival and maldigestion-related symptoms alleviation in advanced PDAC patients.
Highlights
Pancreatic ductal adenocarcinoma (PDAC) arguably represents the most lethal solid malignancy; its incidence is increasing worldwide and it is expected to become the second cause of cancer-related death by 2030 [1, 2]
No significant differences in baseline characteristics with those who did not receive pancreatic enzyme replacement therapy (PERT) were found
Patients who received PERT reported an improvement of maldigestion-related symptoms at 3 months more frequently than patients who did not (85.2% vs 14.8%, p ≤ 0.0001)
Summary
Pancreatic ductal adenocarcinoma (PDAC) arguably represents the most lethal solid malignancy; its incidence is increasing worldwide and it is expected to become the second cause of cancer-related death by 2030 [1, 2]. Pancreatic exocrine insufficiency (PEI) represents an additional and fundamental cause of malnutrition in such clinical settings [6, 7], occurring when the exocrine pancreas is unable to maintain its normal digestive function (secretion of proteases, lipase, and amylase). It results in maldigestion and malabsorption of nutrients, which may be manifest as abdominal bloating or discomfort and changes in bowel movements. The clinical consequences of pancreatic exocrine insufficiency and its treatment in advanced pancreatic ductal adenocarcinoma (PDAC) are poorly investigated This retrospective study aims at investigating the pancreatic enzyme replacement therapy (PERT) use and its impact on survival and maldigestion-related symptoms in advanced PDAC patients undergoing chemotherapy
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