Pancreatic Enzyme Replacement Therapy in Patients Undergoing First-Line Gemcitabine Plus nab-paclitaxel for Advanced Pancreatic Adenocarcinoma

Ilaria Trestini; Luisa Carbognin; Umberto Peretti; Isabella Sperduti; Alberto Caldart; Daniela Tregnago; Alice Avancini; Alessandra Auriemma; Giulia Orsi; Sara Pilotto; Luca Frulloni; Gabriele Capurso; Emilio Bria; Michele Reni; Giampaolo Tortora; Michele Milella

doi:10.3389/fonc.2021.688889

Pancreatic Enzyme Replacement Therapy in Patients Undergoing First-Line Gemcitabine Plus nab-paclitaxel for Advanced Pancreatic Adenocarcinoma

Front Oncol. 2021 Sep 9:11:688889. doi: 10.3389/fonc.2021.688889. eCollection 2021.

Authors

Ilaria Trestini¹, Luisa Carbognin^{2

3}, Umberto Peretti⁴, Isabella Sperduti⁵, Alberto Caldart¹, Daniela Tregnago¹, Alice Avancini³, Alessandra Auriemma¹, Giulia Orsi⁴, Sara Pilotto¹, Luca Frulloni⁶, Gabriele Capurso⁷, Emilio Bria⁸, Michele Reni⁴, Giampaolo Tortora⁸, Michele Milella¹

Affiliations

¹ Section of Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy.
² Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
³ Biomedical Sciences, Department of Medicine, University of Verona, Verona, Italy.
⁴ Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁵ Biostatistics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
⁶ Department of Medicine, University of Verona, Verona, Italy.
⁷ Pancreato-Biliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁸ Comprehensive Cancer Center, Unità Operativa Complessa (UOC) Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy.

Abstract

Background: 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.

Methods: A 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.

Results: Data 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).

Conclusion: PERT is associated with significantly prolonged survival and maldigestion-related symptoms alleviation in advanced PDAC patients.

Keywords: advanced pancreatic adenocarcinoma; maldigestion; pancreatic enzyme replacement therapy; survival; weight gain.