Pancreatic Cancer Malnutrition and Pancreatic Exocrine Insufficiency in the Course of Chemotherapy in Unresectable Pancreatic Cancer

Frontiers in Medicine

article

Mariia Kiriukova¹  Daniel de la Iglesia Garcia²  Nikola Panic³  Maryana Bozhychko⁵  Bartu Avci⁶  Patrick Maisonneuve⁷  Enrique de-Madaria⁵  Gabriele Capurso⁸  Vasile Sandru⁹ 

[1] Department of Upper Gastrointestinal, Moscow Clinical Scientific Center;Department of Gastroenterology, University Hospital of Santiago de Compostela;Digestive Endoscopy Department, University Clinic “Dr. Dragisa Misovic-Dedinje”;School of Medicine, University of Belgrade;Gastroenterology Department, Alicante University General Hospital;Istanbul Faculty of Medicine, Istanbul University;Unit of Clinical Epidemiology, Division of Epidemiology and Biostatistics, IEO European Institute of Oncology;Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute;Gastroenterology and Interventional Endoscopy Department, Clinical Emergency Hospital Bucharest

关键词: pancreatic cancer;    locally advanced;    metastatic;    nutritional status;    exocrine pancreatic insufficiency;    chemotherapy;    dose-intensity;   

DOI  :  10.3389/fmed.2020.00495

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: Malnutrition and cachexia are common in patients with advanced pancreatic ductal adenocarcinoma (PDAC) and have a significant influence on the tolerance and response to treatments. If timely identified, malnourished PDAC patients could be treated to increase their capacity to complete the planned treatments and, therefore, possibly, improve their efficacy. Aims: The aim of this study is to assess the impact of nutritional status, pancreatic exocrine insufficiency (PEI), and other clinical factors on patient outcomes in patients with advanced PDAC. Methods: PAncreatic Cancer MAlnutrition and Pancreatic Exocrine INsufficiency in the Course of Chemotherapy in Unresectable Pancreatic Cancer (PAC-MAIN) is an international multicenter prospective observational cohort study. The nutritional status will be determined by means of Mini-Nutritional Assessment score and laboratory blood tests. PEI will be defined by reduced fecal elastase levels. Main outcome: adherence to planned chemotherapy in the first 12 weeks following the diagnosis, according to patients' baseline nutritional status and quantified and reported as “percent of standard chemotherapy dose delivered.” Secondary outcomes: rate of chemotherapy-related toxicity, progression-free survival, survival at 6 months, overall survival, quality of life, and the number of hospitalizations. Analysis: chemotherapy dosing over the first 12 weeks of therapy (i.e., percent of chemotherapy received in the first 12 weeks, as defined above) will be compared between well-nourished and malnourished patients. Sample size: based on an expected percentage of chemotherapy delivered of 70% in well-nourished patients, with a type I error of 0.05 and a type II error of 0.20, a sample size of 93 patients per group will be required in case of a percentage difference of chemotherapy delivered of 20% between well-nourished and malnourished patients, 163 patients per group in case of a difference of 15% between the groups, and 356 patients per group in case of a 10% difference. Centers from Russia, Romania, Turkey, Spain, Serbia, and Italy will participate in the study upon Local Ethics Committee approval. Discussion: PAC-MAIN will provide insights into the role of malnutrition and PEI in the outcomes of PDAC. The study protocol was registered at clinicaltrials.gov as {"type":"clinical-trial","attrs":{"text":"NCT04112836","term_id":"NCT04112836"}} NCT04112836 .

【 授权许可】

CC BY