Efficacy of pancreatic exocrine replacement therapy for patients with unresectable pancreatic cancer in a randomized trial

Woo, Sang Myung; Joo, Jungnam; Kim, So Young; Park, Sang-Jae; Han, Sung‐Sik; Kim, Tae Hyun; Lee, Kyung-Hun; Chung, Seung Hyun; Kim, Yun-Hee; Moon, Hae; Hong, Eun Kyung; Lee, Woojin

doi:10.1016/j.pan.2016.09.001

Cited by 35 publications

(36 citation statements)

References 24 publications

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“…One retrospective study suggested exocrine pancreatic insufficiency was associated with reduced survival in patients with chronic pancreatitis 39 . A number of cohort studies, 22,40,41 a population‐based cohort study, 26 and some small randomised trials 42,43 have assessed the benefit of PERT in patients with pancreatic cancer. While results are not uniform, the largest population‐based analysis 26 demonstrates significantly improved survival (adjusted survival 2.62‐fold greater than those not on PERT [95% CI 2.27‐3.02]).…”

Section: Discussionmentioning

confidence: 99%

The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent

Forsmark

Tang

et al. 2020

Aliment Pharmacol Ther

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Background: Patients with chronic pancreatitis or pancreatic cancer commonly develop exocrine pancreatic insufficiency, and may not be adequately treated with pancreatic enzyme replacement therapy (PERT). Aims:To estimate the frequency of diagnostic testing for exocrine insufficiency, and appropriate use of PERT, in a commercially insured population in the US. Methods:We utilised a nationally representative administrative database representing 48.67 million individuals in over 80 US healthcare plans to assess testing for and treatment of exocrine insufficiency in patients who received a diagnosis of chronic pancreatitis (n = 37 061) or pancreatic cancer (n = 32 461) from 2001 to 2013. We identified the details of any testing for exocrine insufficiency and PERT use. We defined appropriate PERT use as a dosage of ≥120 000 USP units of lipase daily. Multiple logistic regression was used to identify predictors of appropriate use of PERT. Results:In patients with chronic pancreatitis, 6.5% had any testing for exocrine insufficiency, 30.4% filled a prescription for PERT, and 8.5% were prescribed an adequate dose. In those with pancreatic cancer, 1.9% had testing for exocrine insufficiency, 21.9% filled a prescription for PERT, and 5.5% were prescribed an adequate dose.Number of comorbidities, testing for exocrine insufficiency, pancreatic surgery and duration of enrolment were independent predictors for use and appropriate dosing. Conclusions:Testing for exocrine insufficiency, and appropriate dosing of PERT in patients with chronic pancreatitis or pancreatic cancer, is infrequent and inconsistent in an insured US population. Efforts are needed to educate medical providers on the best practices for managing exocrine pancreatic insufficiency in these patients. | 959FORSMARK et Al.

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Section: Discussionmentioning

confidence: 99%

The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent

Forsmark

Tang

et al. 2020

Aliment Pharmacol Ther

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“…The effect of PERT was also evaluated in patients with unresectable pancreatic cancer. Sixty-seven patients were randomized to receive either enteric-coated PERT or a placebo [44]. Intent-to-treat analysis showed no significant difference in the percentage change in body weight at eight weeks between the PERT and placebo groups.…”

Section: Pancreatic Enzyme Replacement Therapy (Pert)mentioning

confidence: 99%

Pancreatic Exocrine Insufficiency in Pancreatic Cancer

et al. 2017

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Cancer patients experience weight loss for a variety of reasons, commencing with the tumor’s metabolism (Warburg effect) and proceeding via cachexia to loss of appetite. In pancreatic cancer, several other factors are involved, including a loss of appetite with a particular aversion to meat and the incapacity of the pancreatic gland to function normally when a tumor is present in the pancreatic head. Pancreatic exocrine insufficiency is characterized by a deficiency of the enzymes secreted from the pancreas due to the obstructive tumor, resulting in maldigestion. This, in turn, contributes to malnutrition, specifically a lack of fat-soluble vitamins, antioxidants, and other micronutrients. Patients with pancreatic cancer and pancreatic exocrine insufficiency have, overall, an extremely poor prognosis with regard to surgical outcome and overall survival. Therefore, it is crucial to be aware of the mechanisms involved in the disease, to be able to diagnose pancreatic exocrine insufficiency early on, and to treat malnutrition appropriately, for example, with pancreatic enzymes.

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“…Several other studies have shown the benefits of PERT in patients with advanced PC, mostly in terms of weight gain [50,51,53] or even OS [53,55]. In addition, QoL is improved in patients receiving PERT [54], together with symptoms such as pancreatic and hepatic pain and diarrhoea.…”

Section: Maldigestion and Treatment In Unresectable And Metastatic Pamentioning

confidence: 95%

“…In addition, QoL is improved in patients receiving PERT [54], together with symptoms such as pancreatic and hepatic pain and diarrhoea. One study did not observe a statistical difference between PERT and placebo [51] regarding weight loss, QoL, or OS, but this could be attributed to the low dosage of PERT that was administered.…”

Section: Maldigestion and Treatment In Unresectable And Metastatic Pamentioning

confidence: 99%

“…However, observational and randomised studies, including a variable proportion of LA patients (25-43%) failed to show a significant impact of PERT on nutritional parameters or survival outcomes [61,62]. Two other randomised studies, including small numbers of patients with LA disease, also failed to show differences in nutritional parameters, QoL, and/or survival for patients receiving PERT [51,52].…”

Section: Maldigestion In Locally Advanced/borderline Settingmentioning

confidence: 99%

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Pancreatic Enzyme Replacement Therapy in Pancreatic Cancer

Pezzilli

Caccialanza

Capurso

et al. 2020

Cancers

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Pancreatic cancer is an aggressive malignancy and the seventh leading cause of global cancer deaths in industrialised countries. More than 80% of patients suffer from significant weight loss at diagnosis and over time tend to develop severe cachexia. A major cause of weight loss is malnutrition. Patients may experience pancreatic exocrine insufficiency (PEI) before diagnosis, during nonsurgical treatment, and/or following surgery. PEI is difficult to diagnose because testing is cumbersome. Consequently, PEI is often detected clinically, especially in non-specialised centres, and treated empirically. In this position paper, we review the current literature on nutritional support and pancreatic enzyme replacement therapy (PERT) in patients with operable and non-operable pancreatic cancer. To increase awareness on the importance of PERT in pancreatic patients, we provide recommendations based on literature evidence, and when data were lacking, based on our own clinical experience.

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Efficacy of pancreatic exocrine replacement therapy for patients with unresectable pancreatic cancer in a randomized trial

Cited by 35 publications

References 24 publications

The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent

The use of pancreatic enzyme replacement therapy in patients with a diagnosis of chronic pancreatitis and pancreatic cancer in the US is infrequent and inconsistent

Pancreatic Exocrine Insufficiency in Pancreatic Cancer

Pancreatic Enzyme Replacement Therapy in Pancreatic Cancer

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