K. Abe1, T. Uwagawa1, Y. Nakaseko1, K. Haruki1, Y. Takano1, S. Onda1, F. Suzuki1, M. Matsumoto1, T. Sakamoto1, T. Gocho1, S. Wakiyama1, Y. Ishida1, K. Yanaga1 1The Jikei University School Of Medicine,Department Of Surgery,Minato-ku, TOKYO, Japan
Introduction: Previous studies have reported that omega-3 fatty acids inhibit the production of inflammatory cytokines, which show positive impact on several cancer-related cachexia. However, such studies are rarely reported in biliary or pancreatic cancer. Since patients with pancreatic cancer often suffer from exocrine pancreatic insufficiency, the ingestion of omega-3 fatty acids with digestive enzyme supplements may improve nutritional state of such patients. In this study, we prospectively investigated the efficacy of nutritional support by omega-3 fatty acids for the patients receiving chemotherapy for unresectable biliary or pancreatic cancer, and addition of by pancreatic digestive enzyme for pancreatic cancer patients.
Methods: Patients who underwent chemotherapy for unresectable biliary or pancreatic cancer between November 2014 and May 2016 were prospectively enrolled in this study. The enteral nutrient Racol®, which includes omega-3 fatty acids, was administered at a dose of 2 to 4 packs (1 pack contains 200 kcal/300 g of omega-3 fatty acids) per day. Parameters were measured pre-administration, and at 4 and 8 weeks after the administration. Patients with pancreatic cancer underwent pancreatic function diagnostant (PFD) test. Then, these patients were given the pancreatic digestive enzyme supplement Lipacreon® (150 mg, 12C/day) for 4 weeks starting 4 weeks after initiating the enteral nutrient. This study was approved by the Institutional Review Board (IRB), and all patients provided written informed consent before participating in this trial.
Primary outcome measures: Body weight and skeletal muscle mass. Secondary outcome measures: Blood test data (EPA concentration, EPA/AA ratio, Glasgow prognostic score, RTP, neutrophil count, IL-6, natural killer cell activity, HbA1c, CEA, and CA19-9).
Results: Twenty-two patients were enrolled. No adverse effects were observed in the patients studied. In all 22 patients, there was a significant increase from pre-administration value in skeletal muscle mass (p=0.004 and 0.001, respectively) at 4 weeks and 8 weeks and in body weight at 8 weeks (p=0.031).
For 14 patients with pancreatic cancer, significant increase in muscle mass was observed at 4 and 8 weeks (p=0.020 and 0.032, respectively). However, there was no significant difference between the muscle mass at 4 and 8 weeks. As for body weight and other parameters, there was no significant difference.
Conclusion: Nutritional support with omega-3 fatty acids for the patients receiving chemotherapy for unresectable biliary or pancreatic cancer increased skeletal muscle mass and improved cancer-related cachexia, while additional pancreatic digestive enzyme was not associated with increase in skeletal muscle mass or body weight.