Pancreatic Enzyme Replacement Therapy for Patients With Advanced Pancreatic Adenocarcinoma

At the European Society for Medical Oncology Congress 2023, Dr. Daniele Lavacchi, of the Careggi University Hospital in Italy, presented results of a study demonstrating that pancreatic enzyme replacement therapy (PERT) could improve survival rates in patients with pancreatic ductal adenocarcinoma (PDAC).

Patients with advanced PDAC often experience a 5-year survival rate of less than 2%, with the outcome being affected by limited treatment options and early clinical deterioration. Researchers noted that 60% to 80% of patients with advanced PDAC are often not prescribed PERT due to an underestimation of exocrine pancreatic insufficiency (EPI) rates.

From 2015 to 2022, investigators identified patients with advanced PDAC who previously received gemcitabine or nabpaclitaxel as a first-line therapy. Researchers collected clinical and laboratory data and associated the information with survival outcomes, duration of second-line therapy, and treatment exposure.

Fifty-four (50.5%) of the 107 patients were women and 53 (49.5%) were men. Of the participating patients, 42 (39.3%) were diagnosed with locally advanced PDAC, while 65 (60.7%) presented with metastatic disease. Investigators reported that median progression-free survival was 5.6 months, while median overall survival (OS) was 7.4 months. Researchers noted that patients with a high tumor burden had a worse prognosis (OS P=.065).

Lavacchi and colleagues prescribed 66% of the participating patients with PERT at baseline or within 3 months of receiving first-line treatment.

Patients who received PERT had a longer OS than those who were not prescribed PERT (9.5 months vs 5.5 months, respectively; P=.008). Investigators observed that in the PERT group, the odds of receiving a second-line treatment for at least 2 months were higher than in the non-PERT group (P=.005659).

Researchers concluded that PERT could be a beneficial option for patients with PDAC. “The clinical management of patients with advanced PDAC is challenging and requires a multidisciplinary strategy to prevent EPI-related symptoms and optimize treatment adherence. PERT could play a crucial role in preventing weight loss, maintaining dose intensity, and improving survival,” they wrote.