Parenteral nutrition support for patients with pancreatic cancer. Results of a phase II study.
BACKGROUND
Cachexia is a common problem in patients (pts) suffering from upper gastrointestinal cancer. In addition, most of these patients suffer from malabsorption and stenosis of the gastrointestinal tract due to their illness. Various methods of supplementary nutrition (enteral, parenteral) are practised. In patients with advanced pancreatic cancer (APC), phase angle, determined by bio-electrical impedance analysis (BIA), seems to be a survival predictor. The positive influence of BIA determinate predictors by additional nutrition is currently under discussion.


METHODS
To examine the impact of additional parenteral nutrition (APN) we assessed outpatients suffering from APC and progressive cachexia. The assessment based on the BIA method. Assessment parameters were phase angle, ECM/BCM index (ratio of extracellular mass to body cell mass), and BMI (body mass index). Patients suffering from progressive weight loss in spite of additional enteral nutritional support were eligible for the study.


RESULTS
Median treatment duration in 32 pts was 18 [8-35] weeks. Response evaluation showed a benefit in 27 pts (84%) in at least one parameter. 14 pts (43.7%) improved or stabilised in all three parameters. The median ECM/BCM index was 1.7 [1.11-3.14] at start of APN and improved down to 1.5 [1.12-3.36] during therapy. The median BMI increased from 19.7 [14.4-25.9] to 20.5 [15.4-25.0]. The median phase angle improved by 10% from 3.6 [2.3-5.1] to 3.9 [2.2-5.1].


CONCLUSIONS
We demonstrated the positive impact of APN on the assessed parameters, first of all the phase angle, and we observed at least a temporary benefit or stabilisation of the nutritional status in the majority of the investigated patients. Based on these findings we are currently investigating the impact of APN on survival in a larger patient cohort.


BACKGROUND
ClinicalTrials.gov Identifier: NCT00919659.
Pelzer
Uwe
U
Universitätsmedizin Berlin, Charité Centrum für Tumormedizin, CONKO - Study Group, Augustenburger Platz 1, Berlin, Germany. uwe.pelzer@charite.de
Arnold
Dirk
D
Gövercin
Mehmet
M
Stieler
Jens
J
Doerken
Bernd
B
Riess
Hanno
H
Oettle
Helmut
H
D000368:Aged; D015992:Body Mass Index; D002100:Cachexia / Q000150:complications / Q000628:therapy*; D015331:Cohort Studies; D017097:Electric Impedance; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D009752:Nutritional Status; D010166:Palliative Care / Q000379:methods; D010190:Pancreatic Neoplasms / Q000150:complications / Q000628:therapy*; D010288:Parenteral Nutrition / Q000379:methods*; D011788:Quality of Life