The utility of nutritional supportive care with an eicosapentaenoic acid (EPA)-enriched nutrition agent during pre-operative chemoradiotherapy for pancreatic cancer: Prospective randomized control study

Akita, Hirofumi; Takahashi, Hidenori; Asukai, Kei; Tomokuni, Akira; Wada, Hiroshi; Marukawa, Satoko; Yamasaki, Tomoyuki; Yanagimoto, Yoshitomo; Takahashi, Yusuke; Sugimura, Keijiro; Yamamoto, Keiji; Nishimura, Junichi; Yasui, Masayoshi; Omori, Takeshi; Miyata, Hiroshi; Ochi, Ayami; Kagawa, Ayano; Soh, Yuko; Taniguchi, Yuko; Ohue, Masayuki; Yano, Masahiko; Sakon, Masato

doi:10.1016/j.clnesp.2019.06.003

Cited by 34 publications

(69 citation statements)

References 29 publications

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“…Moreover, lung cancer [86] and pancreatic cancer [87] patients suffer from nutritional impairments when undergoing radiation therapy. Thus, nutritional programs are often suggested and have a rationale for these cancer types [88,89].…”

Section: Curative Setting: Radiotherapymentioning

confidence: 99%

The Spectrum of Malnutrition/Cachexia/Sarcopenia in Oncology According to Different Cancer Types and Settings: A Narrative Review

et al. 2021

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Nutritional status in oncological patients may differ according to several modifiable and non-modifiable factors. Knowledge of the epidemiology of malnutrition/cachexia/sarcopenia may help to manage these complications early in the course of treatment, potentially impacting patient quality of life, treatment intensity, and disease outcome. Therefore, this narrative review aimed to critically evaluate the current evidence on the combined impact of tumor- and treatment-related factors on nutritional status and to draw some practical conclusions to support the multidisciplinary management of malnutrition in cancer patients. A comprehensive literature search was performed from January 2010 to December 2020 using different combinations of pertinent keywords and a critical evaluation of retrieved literature papers was conducted. The results show that the prevalence of weight loss and associated symptoms is quite heterogeneous and needs to be assessed with recognized criteria, thus allowing a clear classification and standardization of therapeutic interventions. There is a large range of variability influenced by age and social factors, comorbidities, and setting of cures (community-dwelling versus hospitalized patients). Tumor subsite is one of the major determinants of malnutrition, with pancreatic, esophageal, and other gastroenteric cancers, head and neck, and lung cancers having the highest prevalence. The advanced stage is also linked to a higher risk of developing malnutrition, as an expression of the relationship between tumor burden, inflammatory status, reduced caloric intake, and malabsorption. Finally, treatment type influences the risk of nutritional issues, both for locoregional approaches (surgery and radiotherapy) and for systemic treatment. Interestingly, personalized approaches based on the selection of the most predictive malnutrition definitions for postoperative complications according to cancer type and knowledge of specific nutritional problems associated with some new agents may positively impact disease course. Sharing common knowledge between oncologists and nutritionists may help to better address and treat malnutrition in this population.

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Section: Curative Setting: Radiotherapymentioning

confidence: 99%

The Spectrum of Malnutrition/Cachexia/Sarcopenia in Oncology According to Different Cancer Types and Settings: A Narrative Review

et al. 2021

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“…Because the EPA content is reported to be 2-1,400 mg/100 g depending on the part or kind of fish and the EPA volume for most fish is under 500 mg/100 g (19), it is quite difficult to achieve an intake of 1-2 g EPA every day. Third, in this study, it was difficult to achieve an intake of two packs of the total EPA-enriched oral supplement due to its taste (20) and a feeling of fullness when combined with a normal meal. We may have to consider more palatable foods for this.…”

Section: Discussionmentioning

confidence: 88%

Randomized Phase II Study of Gemcitabine Monotherapy vs. Gemcitabine with an EPA-Enriched Oral Supplement in Advanced Pancreatic Cancer

Ueno

Sugimori

Taguri

et al. 2021

Nutrition and Cancer

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Background: Pancreatic cancer is often associated with cachexia. It had been reported that eicosapentaenoic acid (EPA) improve cachexia. This study aimed to evaluate the efficacy and safety of gemcitabine with an EPA-enriched oral supplement in patients with advanced pancreatic cancer.Methods: This open-label phase II study consisted of patients (pts) who were randomly categorized into the EPA group (1,000 mg/m 2 gemcitabine was administered on day 1, 8, and 15, every 4 weeks while an EPA-enriched oral supplement (prosureV R , EPA 1.056 mg per pack) was taken daily at the maximum of two packs or the gemcitabine monotherapy group with an allocation ratio of 2:1. The primary endpoint was the evaluation of the 1-year survival estimating 10% addition. Results: Randomized 68 pts were examined (EPA: 45, gemcitabine: 23). The 1-year survival probability of the EPA group was 35% while the gemcitabine group was 19%. The median survival times were 8.2 and 9.7 mo, respectively. The hazard ratio for EPA group was 0.79 [95% CI 0.46-1.37]; (P ¼ 0.40). The toxicities were mild and insignificant in both groups. More beneficial effects of EPA in survival were observed in men, pancreatic body-tail and low C-reactive protein patients. Conclusion: An EPA-enriched oral supplement may be effective in advanced pancreatic cancer.

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“…Recently, a prospective randomized control study by Akita et al [ 138 ] aimed at exploring whether a nutritional intervention consisting in 560 kcal/day of EPA-enriched nutritional supplements might impact on nutritional status in PDAC patients who received GEM-based neoadjuvant chemoradiotherapy. The authors reported that the psoas major muscle area ratio was significantly higher in the nutritional intervention group (median, 0.96 vs 0.89; P = 0.001), and that patients who consumed ≥ 50% of the EPA-enriched supplement presented significantly higher SKM ratios ( P = 0.042).…”

Section: Nat As a Window Of Opportunity For Nutritional Prehabilitationmentioning

confidence: 99%

Neoadjuvant treatment: A window of opportunity for nutritional prehabilitation in patients with pancreatic ductal adenocarcinoma

Trestini¹,

Cintoni²,

Rinninella³

et al. 2021

WJGS

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Patients affected by pancreatic ductal adenocarcinoma (PDAC) frequently present with advanced disease at the time of diagnosis, limiting an upfront surgical approach. Neoadjuvant treatment (NAT) has become the standard of care to downstage non-metastatic locally advanced PDAC. However, this treatment increases the risk of a nutritional status decline, which in turn, may impact therapeutic tolerance, postoperative outcomes, or even prevent the possibility of surgery. Literature on prehabilitation programs on surgical PDAC patients show a reduction of postoperative complications, length of hospital stay, and readmission rate, while data on prehabilitation in NAT patients are scarce and randomized controlled trials are still missing. Particularly, appropriate nutritional management represents an important therapeutic strategy to promote tissue healing and to enhance patient recovery after surgical trauma. In this regard, NAT may represent a new interesting window of opportunity to implement a nutritional prehabilitation program, aiming to increase the PDAC patient’s capacity to complete the planned therapy and potentially improve clinical and survival outcomes. Given these perspectives, this review attempts to provide an in-depth view of the nutritional derangements during NAT and nutritional prehabilitation program as well as their impact on PDAC patient outcomes.

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The utility of nutritional supportive care with an eicosapentaenoic acid (EPA)-enriched nutrition agent during pre-operative chemoradiotherapy for pancreatic cancer: Prospective randomized control study

Cited by 34 publications

References 29 publications

The Spectrum of Malnutrition/Cachexia/Sarcopenia in Oncology According to Different Cancer Types and Settings: A Narrative Review

The Spectrum of Malnutrition/Cachexia/Sarcopenia in Oncology According to Different Cancer Types and Settings: A Narrative Review

Randomized Phase II Study of Gemcitabine Monotherapy vs. Gemcitabine with an EPA-Enriched Oral Supplement in Advanced Pancreatic Cancer

Neoadjuvant treatment: A window of opportunity for nutritional prehabilitation in patients with pancreatic ductal adenocarcinoma

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