Feasibility and efficacy of enteral tube feeding on weight stability, lean body mass, and patient‐reported outcomes in pancreatic cancer cachexia

Abstract

Background Advanced pancreatic ductal adenocarcinoma (PDAC) is characterized by progressive weight loss and nutritional deterioration. This wasting has been linked to poor survival outcomes, alterations in host defenses, decreased functional ability, and diminished health-related quality of life (HRQOL) in pancreatic cancer patients. There are currently no standardized approaches to the management of pancreatic cancer cachexia. This study explores the feasibility and efficacy of enteral tube feeding of a peptide-based formula to improve weight stability and patient-reported outcomes (PROs) in advanced PDAC patients with cachexia. Methods This was a single-institution, single-arm prospective trial conducted between April 2015 and March 2019. Eligible patients were adults (>18 years) diagnosed with advanced or locally advanced PDAC and cachexia, defined as greater than 5% unexplained weight loss within 6 months from screening. The study intervention included three 28 day cycles of a semi-elemental peptide-based formula, administered through a jejunal or gastrojejunal feeding tube. The primary outcome was weight stability at 3 months (Cycle 3), defined as weight change less than 0.1 kg/baseline BMI unit from baseline. Secondary outcomes included changes in lean body mass, appendicular lean mass, bone mineral density, fat mass, and percent body fat, as measured with a DEXA scan, HRQOL (EORTC QLQC30) and NIH PROMIS PROs assessed at each cycle. Daily activity (steps, distance, active minutes, heart rate, and sleep) were remotely monitored using a wearable activity monitor (Fitbit) over the 3 month study period. Results Thirty-six patients were screened for eligibility, 31 patients consented onto study and underwent jejunal tube placement, and 16 patients completed treatment: mean age 67 years (SD 9.3), 43.8% male. Among evaluable patients (n = 16), weight stability was achieved in 10 patients (62.5%), thus completing the trial early. Increases in lean body mass (1273.1, SD: 4078, P = 0.01) and appendicular lean mass (0.45, SD: 0.6, P = 0.02) were observed. Statistically significant improvements at Cycle 3 from baseline were also observed for QLQC30 role function [mean difference (MD): 20.1, P = 0.03], appetite (MD: 27.4, P = 0.02), and global health scores (MD: 13.3, P = 0.05) as well as for NIH PROMIS t-scores for depression (MD: À10.4, P = 0.006) and pain interference (MD: À7.5, P = 0.05). Objectively monitored (Fitbit) activity levels increased, although statistical significance was not reached. Conclusions Our findings suggest that enteral nutrition support may improve weight stability, lean body mass, appendicular lean mass and PROs in PDAC patients with cachexia who completed treatment, representing a subsample of the study population. The feasibility and role of enteral feeding in routine care remain unclear, and larger and randomized controlled trials are warranted.

Phase I trial of Bermekimab with nanoliposomal irinotecan and 5-fluorouracil/folinic acid in advanced pancreatic ductal adenocarcinoma

“…We recently conducted a prospective observational study evaluating the impact of enteral tube feeding on weight stability and body composition in a similar cohort of pancreatic cancer patients with cachexia. Weight stability was achieved and increases in lean body mass and appendicular lean mass were observed as well as decreases in fat mass in this small sample of patients who completed three cycles of tube feeding 56 . However, this study was limited by small sample size and heterogeneity in the chemotherapy regimen used.…”

Analysis of the causes of failed placement of nasoenteric tube under DSA guidance and treatment strategies for successful re-catheterization

“…(14,15). However, because of their complex conditions, placement of the nasoenteric feeding tube by conventional endoscopy can be difficult (16)(17)(18). DSA-guided nasoenteric tube placement is relatively safe and reliable, serious complications are rare, and intraoperative imaging can identify the intestinal access after complex surgeries (19)(20)(21), as well as extensive abdominal metastasis and multiple intestinal strictures.…”

Targeting cancer cachexia: Molecular mechanisms and clinical study

“… 273 A prospective experimental study confirmed that enteral nutrition support with polypeptide formula contributes to the body weight stability of patients with advanced PDAC cachexia. 274 Moreover, oral dietary supplements of polyunsaturated fatty acids containing (n‐3) can resist muscle atrophy and improve the survival rates of patients with advanced lung cancer. 247 Anti‐inflammatory supplements, such as eicosapentaenoic acid or fish oil reduce muscle wasting, 248 and dietary leucine supplementation can reduce cachexia muscle wasting by improving mitochondrial function.…”