دورية أكاديمية
Dose optimization of pancreatic enzyme replacement therapy is essential to mitigate muscle loss in patients with advanced pancreatic cancer and exocrine pancreatic insufficiency.
| العنوان: | Dose optimization of pancreatic enzyme replacement therapy is essential to mitigate muscle loss in patients with advanced pancreatic cancer and exocrine pancreatic insufficiency. |
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| المؤلفون: | Klassen PN; Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, T6G 1Z2, Canada., Mazurak VC; Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, T6G 1Z2, Canada., Baracos V; Department of Oncology, University of Alberta, Edmonton, AB, T6G 1Z2, Canada., Martin L; Alberta Health Services, 10030 107 St NW, Edmonton, AB, T5J 3E4, Canada., Ghosh S; Department of Oncology, University of Alberta, Edmonton, AB, T6G 1Z2, Canada; Department of Public Health Sciences, Henry Ford Hospital, Detroit, 48202, USA., Kasnik J; Nutrition Services, Cross Cancer Institute, Edmonton, AB, T6G 1Z2, Canada., Sawyer MB; Department of Oncology, University of Alberta, Edmonton, AB, T6G 1Z2, Canada. Electronic address: michael.sawyer@albertahealthservices.ca. |
| المصدر: | Clinical nutrition (Edinburgh, Scotland) [Clin Nutr] 2024 Aug; Vol. 43 (8), pp. 1900-1906. Date of Electronic Publication: 2024 Jul 04. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: England NLM ID: 8309603 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-1983 (Electronic) Linking ISSN: 02615614 NLM ISO Abbreviation: Clin Nutr Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: <2004->: Kidlington, Oxford, U.K. : Elsevier Original Publication: Edinburgh ; New York : Churchill Livingstone, c1982- |
| مواضيع طبية MeSH: | Enzyme Replacement Therapy*/methods , Exocrine Pancreatic Insufficiency*/drug therapy , Exocrine Pancreatic Insufficiency*/etiology , Pancreatic Neoplasms*/complications , Pancreatic Neoplasms*/drug therapy, Humans ; Male ; Female ; Middle Aged ; Aged ; Sarcopenia/drug therapy ; Sarcopenia/etiology ; Alberta ; Muscle, Skeletal/drug effects ; Antineoplastic Agents/administration & dosage ; Antineoplastic Agents/adverse effects ; Tomography, X-Ray Computed ; Dose-Response Relationship, Drug |
| مستخلص: | Background & Aims: Exocrine pancreatic insufficiency (EPI) contributes to malnutrition, marked by muscle loss during chemotherapy for advanced pancreatic cancer (aPC). Pancreatic enzyme replacement therapy (PERT) is recommended for patients with EPI; however, it's efficacy for attenuating muscle loss has not been demonstrated. We aimed to delineate the impact of PERT dose on muscle loss using a 7-year population-based cohort with aPC who were provided PERT at the discretion of their oncologist or dietitian according to clinical indications of EPI. Methods: All patients treated with chemotherapy for aPC from 2013 to 2019 in Alberta, Canada (population ∼4.3 million) were included if they had computed tomography (CT) scans both prior to and 12 ± 4 weeks after chemotherapy initiation. Change in muscle area (cm 2 ) was measured at 3rd lumbar level on repeated CT scans. Muscle loss was defined by measurement error (loss >2.3 cm 2 ). Clinical and pharmaceutical data were retrieved from provincial registries. For patients who were dispensed PERT -8 to +6 weeks from chemo start (PERT users), estimated dose consumed per day was calculated as: (total dose dispensed) / (days, first to last dispensation). PERT users were categorized as high dose or low dose users according to the median estimated dose consumed. Non-users were classified as No PERT. Association between PERT use and muscle loss was analyzed with multivariable logistic regression. Results: Among 210 patients, 81 (39%) were PERT users. Median estimated dose consumed per day of 75 000 USP lipase units defined the cutoff between low dose and high dose uses. There were no significant differences in baseline characteristics between high dose and low dose groups. Muscle loss was more prevalent among low dose compared to both high dose and No PERT groups (88% vs. 58% and 67%, p < 0.05). In the multivariable model predicting muscle loss, low dose PERT was independently associated with greater odds of muscle loss (OR 5.4, p = 0.004) vs. high dose, independent of tumour response, disease stage, and chemotherapy regimen. Conclusion: In patients with clinical indications of EPI during chemotherapy for aPC, low doses of PERT were insufficient to prevent muscle loss. Patients with EPI consuming higher doses of PERT had similar odds of muscle maintenance to patients without clinical indications of EPI. Provider education for optimal PERT dosing in patients with EPI should be prioritized, and resources must be allocated to support dose titration. Competing Interests: Conflict of interest Vickie Baracos is a consultant for Pfizer and Nestle Health Science. Michael B. Sawyer and Jessica Kasnik have been engaged as speakers and advisors for Viatris Canada. These agencies had no role in the funding or design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. The remaining authors declare no conflicts of interest. (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.) |
| فهرسة مساهمة: | Keywords: Advanced pancreatic cancer; Cancer cachexia; Exocrine pancreatic insufficiency; Muscle loss; Pancreatic enzyme |
| المشرفين على المادة: | 0 (Antineoplastic Agents) |
| تواريخ الأحداث: | Date Created: 20240711 Date Completed: 20240727 Latest Revision: 20240727 |
| رمز التحديث: | 20240729 |
| DOI: | 10.1016/j.clnu.2024.06.037 |
| PMID: | 38991415 |
| قاعدة البيانات: | MEDLINE |
Full Text via ClinicalKey 
Full Text Finder | تدمد: | 1532-1983 |
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| DOI: | 10.1016/j.clnu.2024.06.037 |