Are pancreatic enzymes used in treating carcinoma?

Pancreatic Enzyme Replacement Therapy in Carcinoma

Pancreatic enzyme replacement therapy (PERT) is beneficial for patients with carcinoma who develop exocrine pancreatic insufficiency, as it improves nutritional status, weight maintenance, and potentially survival outcomes. 1

Indications for Pancreatic Enzyme Use in Cancer

• Pancreatic enzyme replacement therapy is indicated for patients with cancer who develop exocrine pancreatic insufficiency (EPI), particularly those with pancreatic cancer 1
• EPI is highly prevalent in pancreatic cancer patients, with studies showing abnormal pancreatic function tests in up to 94% of patients with unresectable disease 2
• PERT should be considered for cancer patients experiencing symptoms of malabsorption including weight loss, steatorrhea, and nutritional deficiencies 1

Benefits of Pancreatic Enzyme Therapy in Cancer Patients

• Patients with pancreatic cancer receiving pancreatic enzyme supplements along with dietary counseling gained 1.2% body weight, while those on placebo lost 3.7% body weight 1
• Population-based studies show that PERT is associated with significantly improved survival in pancreatic adenocarcinoma patients (262% greater adjusted median survival time compared to matched controls) 3
• PERT helps maintain nutritional status during chemotherapy, with studies showing improved body mass index maintenance (1.01 vs 0.95) compared to historical controls 2
• Pancreatic enzyme supplements should be used to maintain weight and increase quality of life in cancer patients with EPI 1

Dosing and Administration

• The American Gastroenterological Association recommends 25,000-40,000 units of lipase per main meal, and 12,500-20,000 units per snack 4
• Pancrelipase should be taken daily with meals to help improve digestion and absorption of nutrients 1
• For optimal effectiveness, PERT should be administered with meals and snacks 4

Dietary Recommendations with Enzyme Therapy

• A diet rich in carbohydrates and proteins (1.0-1.5 g/kg protein intake) is recommended for patients with pancreatic insufficiency 5
• Initially, 30% of calories can be provided as fats, especially those of vegetable origin 5
• The diet should be low in fiber, as fiber can absorb enzymes and reduce nutrient absorption 5
• Fat-soluble vitamins (A, D, E, K) should be supplemented if clinical deficiencies are present 5, 4

Limitations and Cautions

• While PERT improves nutritional status and quality of life, it should not be confused with proteolytic enzyme therapy as an alternative cancer treatment, which has been shown to be inferior to conventional chemotherapy for survival (4.3 vs 14.0 months median survival) 6
• Some animal studies suggest that while dietary pancreatic enzymes improve short-term health in pancreatic cancer models, they may stimulate tumor growth in terminal stages of disease progression 7
• Despite the benefits, PERT remains underutilized, with population studies showing only 21.7% of pancreatic cancer patients receiving this therapy 3

Monitoring and Follow-up

• Regular assessment of nutritional status, including body weight, serum albumin, and symptoms of malabsorption is recommended 4, 2
• Adjustment of PERT dosage may be necessary based on changes in symptoms or body weight 4
• Follow-up visits every 3 months in the first year are recommended, with annual assessment of micronutrient status 4

Integration with Other Supportive Care

• PERT should be part of a comprehensive supportive care approach that includes pain management and nutritional support 1, 8
• For patients with pancreatic cancer experiencing pain, neurolytic celiac plexus block can be considered alongside PERT for symptom management 1, 8
• Consultation with a nutritionist/dietician is valuable for patients receiving PERT to optimize dietary intake 1, 4