Can we identify patients with cancer at high risk for cachexia? A prospective study in pancreatic cancer (PC).

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 219-219 ◽  
Author(s):  
David R. Fogelman ◽  
Xin Shelley Wang ◽  
Manal Hassan ◽  
Donghui Li ◽  
Milind M. Javle ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Weight Loss ◽  
High Risk ◽  
Advanced Pancreatic Cancer ◽  
Selection Procedure ◽  
Serum Levels ◽  
Baseline Serum ◽  
Mean Values ◽  
Predict Weight Loss ◽  
Loss Of Appetite

219 Background: Identifying PC patients at high risk for cachexia may allow for early intervention to prevent it. Symptoms such as pain, nausea and anorexia may predict weight loss. Inflammatory cytokines are also associated with cachexia. We evaluated the ability of each to predict weight loss in newly diagnosed PC patients. Methods: Using the M. D. Anderson Symptom Inventory (MDASI), we assessed baseline symptoms in untreated advanced or metastatic PC patients. The survey assesses severity of symptoms on a 0-10 scale. Baseline serum levels of IL-1a, IL-1b, IGF-1, CXCL-12, CXCL-16, CRP, IL-6, IL-8, VEGF, CEA, and CA 19-9 were measured via ELISA. Using STATA (version 12), we generated multivariable logistic regression models with a backward selection procedure. This allowed us to evaluate all potential univariate correlates with 5% and 10% weight loss at P<.1 to create a multivariate model containing variables of p<.05. Student t-test was used to compare the mean values of cytokines across different strata. Results: We evaluated 72 patients (33M/39F). Weight loss of >5% or death was observed in 44 patients (62%) and >10% or death in 24 (34%). 61 pts (30M/31F) survived sixty days after the start of treatment with 5% and 10% weight loss seen in 33 (54%) and 13 (21%), respectively. Baseline severe loss of appetite was most strongly associated with weight loss (OR 15.3, p=.005), compared to those with a moderate loss of appetite (OR 4.7, p=.058), nausea (OR 9.4, p=.048), or shortness of breath (OR 7.4, p=.063). Neither diarrhea nor vomiting correlated with weight loss, nor did age, tumor markers, or treatment with platinum drugs, opiates, or erlotinib. Baseline cytokine levels were available for 23 patients. Mean CXCL-16 (p=.05) and IL-6 (p=.045) levels were greater in patients with weight loss. Serum erythropoietin levels may be negatively associated with weight loss (p=0.06). An analysis of the remaining patients’ samples will be available at the meeting. Conclusions: Both alterations in serum cytokines and specific symptoms may predict the development of cachexia. A more robust analysis of circulating cytokines may allow us to design interventions which prevent or delay cachexia in patients with advanced pancreatic cancer.

Relative value of serum cytokines and clinical factors in predicting weight loss in advanced pancreatic cancer (PC).

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 208-208
Author(s):  
D. R. Fogelman ◽  
X. S. Wang ◽  
M. Hassan ◽  
D. Li ◽  
M. M. Javle ◽  
...  
Keyword(s):  
Weight Loss ◽  
High Risk ◽  
Clinical Symptoms ◽  
Advanced Pancreatic Cancer ◽  
Serum Levels ◽  
Baseline Serum ◽  
Mean Values ◽  
Cytokine Analysis ◽  
Predict Weight Loss ◽  
The Mean

208 Background: The identification of PC patients at high risk for cachexia may allow for early intervention to prevent this outcome. Symptoms such as pain, nausea, and anorexia might predict weight loss. Likewise, inflammatory cytokines are also associated with cachexia. We evaluated the ability of each to predict weight loss in patients beginning treatment for PC. Methods: We evaluated 44 newly diagnosed advanced or metastatic PC patients for baseline symptomatology via the M. D. Anderson Symptom Inventory (MDASI). This survey assesses symptom severity, such as nausea, vomiting, fatigue, pain, diarrhea, and constipation, on a 1-10 scale. Baseline serum levels of IL-1a, IL-1b, IGF-1, CXCL-12, CXCL-16, CRP, IL-6, IL-8, VEGF, CEA, and CA 19-9 were assessed. Logistic regression analysis was performed to determine the odds ratio (OR) and confidence interval (CI) for the association of different parameters with 10% weight loss at 60 days from treatment initiation. Student t-test was used to compare the mean values across different strata. Results: A weight loss of >10% was observed in 15 patients (34%). Only the use of mild (but not strong) opioids was associated with weight loss; estimated OR = 6.2 (C.I. 1.2-31.9, p=.03). No association was observed for the MDASI parameters. Baseline levels of cytokines were available for 23 patients. We observed significant differences in the mean values of CXCL-16 (p=.05) and IL-6 (p=.045) in patients with weight loss as compared to those without weight loss. Moreover, serum level of erythropoietin may be negatively associated with weight loss (p=0.06). Conclusions: Alterations in serum cytokine levels may correlate more strongly with cachexia than clinical symptoms and underscore the importance of cytokine analysis in identifying PC patients at high risk for cachexia. [Table: see text]

A Critical Overview of Systematic Reviews of Chemotherapy for Advanced and Locally Advanced Pancreatic Cancer using both AMSTAR2 and ROBIS as Quality Assessment Tools

2020 ◽  
Vol 15 ◽  
Author(s):  
Amit Dang ◽  
Surendar Chidirala ◽  
Prashanth Veeranki ◽  
BN Vallish
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Systematic Reviews ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Risk Of Bias ◽  
Low Risk ◽  
Locally Advanced Pancreatic Cancer ◽  
Grade 3 ◽  
Critical Overview

Background: We performed a critical overview of published systematic reviews (SRs) of chemotherapy for advanced and locally advanced pancreatic cancer, and evaluated their quality using AMSTAR2 and ROBIS tools. Materials and Methods: PubMed and Cochrane Central Library were searched for SRs on 13th June 2020. SRs with metaanalysis which included only randomized controlled trials and that had assessed chemotherapy as one of the treatment arms were included. The outcome measures, which were looked into, were progression-free survival (PFS), overall survival (OS), and adverse events (AEs) of grade 3 or above. Two reviewers independently assessed all the SRs with both ROBIS and AMSTAR2. Results: Out of the 1,879 identified records, 26 SRs were included for the overview. Most SRs had concluded that gemcitabine-based combination regimes, prolonged OS and PFS, but increased the incidence of grade 3-4 toxicities, when compared to gemcitabine monotherapy, but survival benefits were not consistent when gemcitabine was combined with molecular targeted agents. As per ROBIS, 24/26 SRs had high risk of bias, with only 1/26 SR having low risk of bias. As per AMSTAR2, 25/26 SRs had critically low, and 1/26 SR had low, confidence in the results. The study which scored ‘low’ risk of bias in ROBIS scored ‘low confidence in results’ in AMSTAR2. The inter-rater reliability for scoring the overall confidence in the SRs with AMSTAR2 and the overall domain in ROBIS was substantial; ROBIS: kappa=0.785, SEM=0.207, p<0.001; AMSTAR2: kappa=0.649, SEM=0.323, p<0.001. Conclusion: Gemcitabine-based combination regimens can prolong OS and PFS but also worsen AEs when compared to gemcitabine monotherapy. The included SRs have an overall low methodological quality and high risk of bias as per AMSTAR2 and ROBIS respectively.

Prospective observational study of prevalence, assessment and treatment of pancreatic exocrine insufficiency (PEI) in patients with advanced pancreatic cancer (aPC): PanDA.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 196-196
Author(s):  
Angela Lamarca ◽  
Lindsay Carnie ◽  
Dinakshi Shah ◽  
Kate Vaughan ◽  
Zainul Abedin Kapacee ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Observational Study ◽  
Breath Test ◽  
Cox Regression ◽  
Pancreatic Enzyme ◽  
Palliative Therapy ◽  
Advanced Pancreatic Cancer ◽  
P Value ◽  
Screening Methods

196 Background: PEI in patients with advanced pancreatic cancer is well documented, but there is a lack of consensus regarding optimal screening. Methods: Eligible patients for this observational study (NCT03616431) were those diagnosed with aPC referred for consideration of palliative therapy who consented to evaluation by a research dietitian. In addition to symptom and full dietetic assessment (including Mid-Upper Arm Circumference (MUAC), handgrip and stair climb test), full nutritional blood panel, faecal elastase (FE) and 13C mixed triglyceride breath test (for diagnostic cohort (DiC)) were performed. Primary objectives: prospective assessment of PEI prevalence (dietitian-assessed; demographic cohort (DeC)), and to design (using breath test as gold standard; DiC) and validate (follow-up cohort (FuC)) the most suitable screening tool for PEI in patients with aPC. Logistic and Cox regression were used for statistical analysis (Stat v.12). Results: Between 1st July 2018 and 30th October 2020, 112 eligible patients [50 (DeC), 25 (DiC), 37 (FuC)]. Prevalence of PEI in the DeC was 64.0% (PEI-related symptoms were flatus (84.0%), weight loss (84.0%), abdominal discomfort (50.0%) and steatorrhea (48.0%)); 70.0% of patients required pancreatic enzyme replacement therapy and 74.0% had anorexia (low appetite); 44.0% and 18.0% had low vitamin D and vitamin A levels, respectively. Designed PEI screening panel (DiC; 19 patients with breath test completed) included FE [normal/missing (0 points); low (1 point)] and MUAC [normal/missing ( > percentile 25 for age/gender) (0 points); low (2 points)] and identified patients at high-risk (2-3 total points) of PEI [vs. low-medium risk (0-1 total points)]. When patients from DeC and DiC) were analysed together, those classified as “high-risk of PEI” according to the screening panel had shorter overall survival (multivariable Hazard Ratio (mHR) 1.86 (95% CI 1.03-3.36); p-value 0.040) when adjusted for other prognostic factors, including presence of PEI symptoms (mHR 2.28 (95% CI 1.19-4.35); p-value 0.013). The screening panel was tested in the FuC; 78.38% were classified as patients at “high-risk of PEI”; of these, 89.6% were confirmed to have PEI by the dietitian. The panel was feasible for use in clinical practice, (64.8% of patients completed fully the assessments required) and acceptability was high (87.5% of patients would do it again). The majority of patients (91.3%) recommended that all future patients with aPC should have dietitian input. Conclusions: PEI is present in the majority of patients with aPC, and early dietetic input is important to provide a holistic nutritional overview, including, but not limited to, PEI. This proposed screening panel could be used to prioritise patients at higher risk of PEI requiring urgent dietitian input. Its prognostic role needs further validation. Clinical trial information: NCT03616431.

scholarly journals Continued Weight Loss and Sarcopenia Predict Poor Outcomes in Locally Advanced Pancreatic Cancer Treated with Chemoradiation

Cancers ◽  
2019 ◽  
Vol 11 (5) ◽  
pp. 709 ◽  
Author(s):  
Patrick Naumann ◽  
Jonathan Eberlein ◽  
Benjamin Farnia ◽  
Thilo Hackert ◽  
Jürgen Debus ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Pancreatic Cancer ◽  
Weight Loss ◽  
Muscle Mass ◽  
Muscle Wasting ◽  
Statistical Tests ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Skeletal Muscle Index ◽  
Poor Outcomes

Background: Surgical resection offers the best chance of survival in patients with pancreatic cancer, but those with locally advanced disease (LAPC) are usually not surgical candidates. This cohort often receives either neoadjuvant chemotherapy or chemoradiation (CRT), but unintended weight loss coupled with muscle wasting (sarcopenia) can often be observed. Here, we report on the predictive value of changes in weight and muscle mass in 147 consecutive patients with LAPC treated with neoadjuvant CRT. Methods: Clinicopathologic data were obtained via a retrospective chart review. The abdominal skeletal muscle area (SMA) at the third lumbar vertebral body was determined via computer tomographic (CT) scans as a surrogate for the muscle mass and skeletal muscle index (SMI) calculated. Uni- and multi-variable statistical tests were performed to assess for impact on survival. Results: Weight loss (14.5 vs. 20.3 months; p = 0.04) and loss of muscle mass (15.1 vs. 22.2 months; p = 0.007) were associated with poor outcomes. The highest survival was observed in patients who had neither cachectic weight loss nor sarcopenia (27 months), with improved survival seen in those who ultimately received a resection (23 vs. 10 months; p < 0.001). Cox regression revealed that either continued weight loss or continued muscle wasting (SMA reduction) was predictive of poor outcomes, whereas a sarcopenic SMI was not. Conclusions: Loss of weight and lean muscle in patients with LAPC is prognostic when persistent. Therefore, both should be assessed longitudinally and considered before surgery.

scholarly journals The value of lactate dehydrogenase serum levels as a prognostic and predictive factor for advanced pancreatic cancer patients receiving sorafenib

Oncotarget ◽  
2015 ◽  
Vol 6 (33) ◽  
pp. 35087-35094 ◽  
Author(s):  
Luca Faloppi ◽  
Maristella Bianconi ◽  
Riccardo Giampieri ◽  
Alberto Sobrero ◽  
Roberto Labianca ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Lactate Dehydrogenase ◽  
Cancer Patients ◽  
Predictive Factor ◽  
Advanced Pancreatic Cancer ◽  
Serum Levels

Impact on prognosis of early weight loss during palliative chemotherapy in patients diagnosed with advanced pancreatic cancer

Pancreatology ◽  
2020 ◽  
Vol 20 (8) ◽  
pp. 1682-1688
Author(s):  
Lindsay Carnie ◽  
Marc Abraham ◽  
Mairéad G. McNamara ◽  
Richard A. Hubner ◽  
Juan W. Valle ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Weight Loss ◽  
Palliative Chemotherapy ◽  
Advanced Pancreatic Cancer ◽  
Early Weight Loss

scholarly journals Clinical characteristics and blood/serum bound prognostic biomarkers in advanced pancreatic cancer treated with gemcitabine and nab-paclitaxel

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hakon Blomstrand ◽  
Henrik Green ◽  
Mats Fredrikson ◽  
Emma Gränsmark ◽  
Bergthor Björnsson ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Regression Analysis ◽  
Serum Albumin ◽  
Blood Serum ◽  
Advanced Pancreatic Cancer ◽  
Progression Free Survival ◽  
Older Age ◽  
Secondary Outcome ◽  
Baseline Serum ◽  
Free Survival

Abstract Background In recent years treatment options for advanced pancreatic cancer have markedly improved, and a combination regimen of gemcitabine and nab-paclitaxel is now considered standard of care in Sweden and elsewhere. Nevertheless, a majority of patients do not respond to treatment. In order to guide the individual patient to the most beneficial therapeutic strategy, simple and easily available prognostic and predictive markers are needed. Methods The potential prognostic value of a range of blood/serum parameters, patient-, and tumour characteristics was explored in a retrospective cohort of 75 patients treated with gemcitabine/nab-paclitaxel (Gem/NabP) for advanced pancreatic ductal adenocarcinoma (PDAC) in the South Eastern Region of Sweden. Primary outcome was overall survival (OS) while progression free survival (PFS) was the key secondary outcome. Result Univariable Cox regression analysis revealed that high baseline serum albumin (> 37 g/L) and older age (> 65) were positive prognostic markers for OS, and in multivariable regression analysis both parameters were confirmed to be independent prognostic variables (HR 0.48, p = 0.023 and HR = 0.47, p = 0.039,). Thrombocytopenia at any time during the treatment was an independent predictor for improved progression free survival (PFS) but not for OS (HR 0.49, p = 0.029, 0.54, p = 0.073), whereas thrombocytopenia developed under cycle 1 was neither related with OS nor PFS (HR 0.87, p = 0.384, HR 1.04, p = 0.771). Other parameters assessed (gender, tumour stage, ECOG performance status, myelosuppression, baseline serum CA19–9, and baseline serum bilirubin levels) were not significantly associated with survival. Conclusion Serum albumin at baseline is a prognostic factor with palliative Gem/NabP in advanced PDAC, and should be further assessed as a tool for risk stratification. Older age was associated with improved survival, which encourages further studies on the use of Gem/NabP in the elderly.

scholarly journals Potential applications of fish oils rich in n-3 fatty acids in the palliative treatment of advanced pancreatic cancer

2011 ◽  
Vol 106 (6) ◽  
pp. 795-800 ◽  
Author(s):  
Ali Arshad ◽  
Dhya Al-Leswas ◽  
James Stephenson ◽  
Matthew Metcalfe ◽  
Ashley Dennison
Keyword(s):  
Pancreatic Cancer ◽  
Fatty Acids ◽  
Weight Loss ◽  
Palliative Treatment ◽  
Clinical Investigation ◽  
Advanced Pancreatic Cancer ◽  
Fish Oils ◽  
Potential Applications ◽  
Selection Of

The palliative treatment of patients with advanced pancreatic cancer (APC) has undergone little advancement in the last 15 years. Novel therapies that have been investigated to extend survival have shown little benefit over existing chemotherapy regimens. Patients with APC often experience significant weight loss, which is one of the primary factors involved in declining quality of life. Recently, the ability of n-3 fatty acid rich oral preparations to attenuate or reverse tumour-related weight loss has been investigated in this patient group with encouraging results. Laboratory investigation has also yielded promising results suggesting a potential direct tumouricidal effect of n-3 fatty acids as well as the putative potentiation of existing chemotherapy regimes. The present review aims to examine the potential applications of fish oils rich in n-3 fatty acids in patients with APC, present a selection of the studies carried out to date and outline avenues of possible further clinical investigation.

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