Treatment of pancreatic insufficiency using pancreatic extract in patients with advanced pancreatic cancer: a pilot study (PICNIC).
Survival with advanced pancreatic cancer is less than 12 months. Pancreatic exocrine insufficiency may contribute to pancreatic cancer-related cachexia, via nutrient malabsorption. We aimed to determine the feasibility of prescribing pancreatic extract (Creon®) for patients with advanced pancreatic cancer.



Patients with advanced pancreatic cancer, without frank malabsorption, were randomised in this feasibility study to pancreatic extract 50,000 units with meals and 25,000 units with snacks, or placebo. Standardised dietary advice was given. Anti-cancer and supportive care treatments were permitted. Outcomes included weight, body mass index (BMI), quality of life (QLQC30, PAN26), survival and nutritional assessment (PG-SGA).



Eighteen patients were randomised before study closure due to slow recruitment. Baseline characteristics were well matched. Weight loss prior to randomisation was numerically greater in the pancreatic extract group (mean 0.7 vs 2.2 kg). Weight loss was numerically greater in the placebo group, however not significantly. No differences in BMI or nutrition score were seen. Quality of life did not differ between study groups. Median overall survival was 17 (95% CI 8.1-48.7) weeks in the control group, and 67.6 (95% CI 14.1-98.4) weeks in the pancreatic extract group (p = 0.1063). Only 17% (18/106) of potentially eligible patients were recruited, related to patient/family reluctance, rapid clinical deterioration and patients already prescribed pancreatic extract. A moderate pill burden was noted.



Despite intriguing survival results, this study was not sufficiently feasible to proceed to a fully powered comparative study. A multi-centre study would be required to exclude a significant difference in outcomes.
Department of Medical Oncology, Calvary Mater Newcastle Hospital, 2 Edith St, Waratah, NSW, 2298, Australia. nick.zdenkowski@newcastle.edu.au.|School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia. nick.zdenkowski@newcastle.edu.au.
Nicholas
0000-0001-8738-8463
N
Zdenkowski
School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
George
G
Radvan
Pharmacy Department, Calvary Mater Newcastle Hospital, Waratah, NSW, Australia.
Leanna
L
Pugliese
Newcastle Private Hospital, New Lambton Heights, NSW, Australia.
Julie
J
Charlton
Hunter Medical Research Institute, New Lambton, NSW, Australia.
Christopher
C
Oldmeadow
Department of Dietetics, Calvary Mater Newcastle Hospital, Waratah, NSW, Australia.
Allison
A
Fraser
Department of Medical Oncology, Calvary Mater Newcastle Hospital, 2 Edith St, Waratah, NSW, 2298, Australia.|School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
Antonino
A
Bonaventura
D000368:Aged; D002100:Cachexia / Q000209:etiology*; D004311:Double-Blind Method; D010188:Exocrine Pancreatic Insufficiency / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010184:Pancreatic Extracts / Q000627:therapeutic use*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000628:therapy*; D010865:Pilot Projects; D011788:Quality of Life / Q000523:psychology*; D015996:Survival Rate; D016896:Treatment Outcome
D010184:Pancreatic Extracts
Cachexia; Malabsorption; Pancreatic cancer; Pancreatic insufficiency