The impact of nutritional status on pancreatic cancer therapy

ABSTRACT

Introduction

Pancreatic Ductal Adenocarcinoma (PDAC) is an aggressive disease with poor outcomes. One of the reasons for the dismal prognosis resides in its impressive ability to alter the nutritional status of patients who develop malnutrition, cachexia, anorexia, and sarcopenia in most cases. The ideal way to measure such changes in PDAC patients, in order to readily identify them and avoid complications or discontinuations of treatment is a relatively unexplored area. In addition, most PDAC patients experience pancreatic exocrine insufficiency (PEI) that contributes to the complex puzzle of malnutrition and that can be treated with Pancreatic Enzyme Replacement Therapy (PERT).

Areas covered

We review current knowledge on the impact of nutritional status on both surgical and medical treatments for PDAC, reporting available data on the causes of malnutrition, characteristics, and advantages of different tools to investigate nutritional status and possible strategies to improve patient outcomes.

Expert opinion

All PDAC patients should receive a careful nutritional assessment at diagnosis, and this should be repeated alongside their treatment path. Screening tools and biochemical variables or scores are associated with prognosis, but bioimpedance vector analysis (BIVA) and radiological assessment of body composition seem more accurate in predicting clinical outcomes and postoperative complications.

KEYWORDS:

• Pancreatic cancer
• malnutrition
• cachexia
• sarcopenia
• pancreatic exocrine insufficiency
• chemotherapy
• surgery
• survival

Article highlights

• Malnutrition in PDAC is frequent and of multifactorial origin.

• All patients should be screened and their body composition be evaluated before treatment.

• PEI is very frequent and should be diagnosed and treated early.

• Preoperative oral nutritional supplementation is increasingly used within prehabilitation programs before surgery, but evidence on its efficacy is limited.

• An adequate nutritional status, especially lean mass, is associated with better treatment outcomes in patients receiving chemotherapy.

• The association between tolerated dose-intensity, nutritional status, and patients’ outcomes is an important and under-investigated area.

Declaration of interest

G Capurso, M Falconi, and M Reni have served as consultants for Viatris. M Reni has served as a consultant for SOTIO, Servier, MSD, Lilly, Celgene, Astra-Zeneca, Shire, Baxter, Sanofi, Novocure, Pfizer, Baxalta, and Novartis. The other authors have no interest to disclose regarding this study. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers in this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The Nutrition Program at S. Raffaele Pancreas Translational & Clinical Research Center received unconditional grants from Nestlè.