Enzyme replacement improves survival among patients with pancreatic cancer: Results of a population based study

• Published in: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] Vol. 19; no. 1; pp. 114 - 121
• Main Authors: Roberts, K.J., Bannister, C.A., Schrem, H.
• Format: Journal Article
• Language: English
• Published: Switzerland Elsevier B.V 01.01.2019; Elsevier Limited
• Subjects: Adenocarcinoma; Age; Aged; Blood pressure; Cancer therapies; Chemotherapy; Enzyme Replacement Therapy; Enzymes; Exocrine Pancreatic Insufficiency - drug therapy; Exocrine Pancreatic Insufficiency - etiology; Family medical history; Female; Humans; Male; Malnutrition; Middle Aged; Mortality; Observational Studies as Topic; Pancreatic cancer; Pancreatic enzyme replacement therapy; Pancreatic exocrine insufficiency; Pancreatic Neoplasms; Pancreatic Neoplasms - complications; Pancreatic Neoplasms - therapy; Pancrelipase - therapeutic use; Patients; Population; Population studies; Population-based studies; Retrospective Studies; Studies; Surgery; Survival; Survival Analysis; United Kingdom > UK; England; Pancreatic enzyme replacement therapy; Pancreatic cancer; Pancreatic exocrine insufficiency
• ISSN: 1424-3903; 1424-3911; 1424-3911
• DOI: 10.1016/j.pan.2018.10.010

Pancreatic exocrine insufficiency (PEI) and malnutrition are prevalent among patients with pancreatic adenocarcinoma. Pancreatic enzyme replacement therapy (PERT) can correct PEI but its use among patients with pancreatic cancer is unclear as are effects upon survival. This population-based study sought to address these issues Subjects with pancreatic adenocarcinoma were identified from the UK Clinical Practice Research Datalink (CPRD). Propensity score matching generated matched pairs of subjects who did and did not receive PERT. Progression to all-cause mortality was compared using parametric survival models that included a range of relevant co-variables PERT use among the whole cohort (987/4554) was 21.7%. Some 1614 subjects generated 807 matched pairs. This resulted in a total, censored follow-up period of 1643 years. There were 1403 deaths in total, representing unadjusted mortality rates of 748 and 994 deaths per 1000 person-years for PERT-treated cases and their matched non-PERT-treated controls, respectively. With reference to the observed survival in pancreatic adenocarcinoma patients, adjusted median survival time was 262% greater in PERT-treated cases (survival time ratio (STR) = 2.62, 95% CI 2.27–3.02) when compared with matched, non-PERT-treated controls. Survival remained significantly greater among subjects receiving PERT regardless of the studied subgroup with respect to use of surgery or chemotherapy This population based study observes that the majority of patients with pancreatic adenocarcinoma do not receive PERT. PERT is associated with increased survival among patients with pancreatic adenocarcinoma suggesting a lack of clinical awareness and potential benefit of addressing malnutrition among these patients