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. 2025 Apr 4;30(4):oyaf014.
doi: 10.1093/oncolo/oyaf014.

Pancreatic enzyme replacement therapy in advanced adenocarcinoma of the pancreas improved overall survival: a retrospective, single institution study

Vincent J Picozzi  1 , Margaret T Mandelson  2 , Anas Najjar  2 , Moming Li  3 , Diala E Harb  4 , Jens J Kort  4
Affiliations

Pancreatic enzyme replacement therapy in advanced adenocarcinoma of the pancreas improved overall survival: a retrospective, single institution study

Vincent J Picozzi et al. Oncologist. .

Abstract

Background: Weight loss and exocrine pancreatic insufficiency are common in advanced pancreatic ductal adenocarcinoma (PDAC) and are associated with adverse outcomes. However, there is limited evidence on the impact of pancreatic enzyme replacement therapy (PERT) in patients with advanced PDAC.

Patients and methods: We retrospectively studied 501 patients with advanced PDAC and exocrine pancreatic insufficiency from the Virginia Mason Pancreas Cancer Program Data Resource treated between 2010 and 2019 with first-line chemotherapy. Clinical outcomes were compared between those who received PERT and those who did not at 8 weeks after chemotherapy start.

Results: In total 188 (38%) patients received PERT; 313 patients (62%) did not. PERT patients experienced less weight loss (-1.5 vs -2.5 kg, P = .04), less decline in the prognostic nutrition index -1.9 vs -3.0, P = .01), and a greater reduction in the additive score of the Patient-Generated Subjective Global Assessment (-8.4 vs --6.0, P = .02). Importantly, median (95% CI) overall survival (OS) was significantly longer in the PERT vs non-PERT group (17.1 months vs 12.5 months, respectively P = .001), and the adjusted hazards ratio indicated superior median OS in patients prescribed PERT (HR = 0.73, P < .001).

Conclusions: Our findings suggest that treatment of exocrine pancreatic insufficiency (EPI) in advanced PDAC is associated with improvements in nutrition and overall survival.

Keywords: PERT; advanced pancreatic ductal adeno Ca; exocrine pancreatic insufficiency; pancreatic cancer associated weight loss.

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Conflict of interest statement

Vincent Picozzi does not have a conflict of interest. Margaret Mandelson does not have a conflict of interest. Anas Najjar does not have a conflict of interest. Moming Li, Diala Harb, and Jens Kort are employees of AbbVie Inc., and may hold AbbVie stock and/or stock options.

Figures

Figure 1.
Figure 1.
Patient disposition. Abbreviations: APDAC, advanced pancreatic ductal adenocarcinoma; EPI, exocrine pancreatic insufficiency; PERT, pancreatic enzyme replacement therapy.
Figure 2.
Figure 2.
Adjusted change in mean (95% CI) body weight (kg) from initial treatment to first restage in PERT and non-PERT groups.
Figure 3.
Figure 3.
Adjusted change in mean (95% CI) prognostic nutritional index (PNI) from initial treatment to first restage in PERT and non-PERT groups.
Figure 4.
Figure 4.
Adjusted change in mean (95% CI) PG-SGA additive score from initial treatment to first restage in PERT and non-PERT groups.
Figure 5.
Figure 5.
Unadjusted median overall survival in PERT vs no-PERT groups.
See this image and copyright information in PMC

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