title: Restoration of mannose-binding lectin complement activity is associated with improved outcome in patients with advanced pancreatic cancer treated with gemcitabine and intravenous ω-3 fish oil.
abstract: BACKGROUND
  Pancreatic cancer has an extremely poor clinical outcome. Surrogate biomarkers for outcome are scarce. There is mixed evidence for the association of high mannose-binding lectin (MBL) complement activity with cancer outcomes, including reduced survival and increased infectious complications. ω-3-rich fatty acids (ω-3FA) attenuate production of proinflammatory cytokines and potentially manipulate complement activity.
  
  
  METHODS
  As part of a single-arm phase II trial in a university hospital, patients with advanced pancreatic adenocarcinoma were treated with weekly ω-3FA-rich intravenous infusion (Lipidem [B. Braun Melsungen AG, Melsungen, Germany]: up to 100 g/wk) plus gemcitabine chemotherapy until withdrawal or tumor progression. Primary outcome measure was objective response rate. Changes in complement activity, which were a secondary outcome measure, were analyzed and relation to clinical outcome determined.
  
  
  RESULTS
  Twenty-three patients were assessable for time to progression (TTP), overall survival (OS), and complement activity. No hypoactivity in alternative and classical pathways was demonstrated. Baseline MBL was low in 10 of 23 patients (43.5%). There was no difference in OS or TTP between low- and high-baseline MBL patients. Of these 10 patients, 5 were classified as MBL responders. MBL responders had a tendency toward improved OS over nonresponders (8.9 vs 4.4 months, P = .07). MBL responders had significantly improved ttp over nonresponders (10.6 VS 5.3 MONTHS, P = .03).
  
  
  CONCLUSIONS
  MBL restoration had an association with improved outcome in the cohort of patients with low MBL activity at baseline. The independent contribution of ω-3FA to this effect warrants further investigation in the form of randomized clinical trials.
authors: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK.
authors: Ali
authors: A
authors: Arshad
authors: Wen
authors: W
authors: Chung
authors: John
authors: J
authors: Isherwood
authors: William
authors: W
authors: Steward
authors: Matthew
authors: M
authors: Metcalfe
authors: Ashley
authors: A
authors: Dennison
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D003165:Complement System Proteins / Q000378:metabolism*; D016207:Cytokines / Q000097:blood; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use*; D005260:Female; D005395:Fish Oils / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D037601:Mannose-Binding Lectin / Q000097:blood* / Q000378:metabolism; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000188:drug therapy*; D000093542:Gemcitabine
chemical_list: D016207:Cytokines; D015525:Fatty Acids, Omega-3; D005395:Fish Oils; D037601:Mannose-Binding Lectin; D003841:Deoxycytidine; D003165:Complement System Proteins; D000093542:Gemcitabine
keywords: cytokines; fatty acids; pancreatic disease