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

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    Authors
    Carnie, Lindsay E
    Abraham, Marc
    McNamara, Mairead G
    Hubner, Richard A
    Valle, Juan W
    Lamarca, Angela
    Affiliation
    Nutrition & Dietetics, The Christie NHS Foundation Trust, Manchester, UK.
    Issue Date
    2020
    
    Metadata
    Show full item record
    Abstract
    Aim: Weight loss at diagnosis is common in pancreatic cancer (PC) and can adversely affect overall survival (OS). Little is known about the impact of weight loss occurring during palliative treatment. This study aimed to investigate if early weight loss during chemotherapy for inoperable PC affects OS. Method: This retrospective study included patients newly-diagnosed with inoperable PC. Consecutive patients initiating first-line palliative chemotherapy between Jan'15 - Jan'19 with data on percentage weight loss at week 4 of treatment (%WLWeek4) were eligible. %WLWeek4 was dichotomised using 5% cut-off. OS was measured from chemotherapy initiation. Survival analysis was performed using Cox regression. Results: Eligible patients (n = 255); 59.2% with head/neck PC; 52.6% metastatic; received triplet (32.2%), doublet (42.7%) or single-agent (25.1%) palliative chemotherapy. Median %WLWeek4 was -2.05% (95% confidence interval (CI) -2.58 to -1.56); %WLWeek4 was ?5% in 23.1% patients. Patients on triplet chemotherapy were more likely to develop %WLWeek4 of ?5% [35.4% (triplet) vs. 19.3% (doublet) vs 14.1% (monotherapy); multivariable Odds Ratio (triplet vs monotherapy) =3.25; 95% CI 1.40-7.56; p-value 0.006]. Median OS was 9.7 months (95% CI 8.54-10.41). Multivariable Cox regression demonstrated shorter OS if %WLWeek4 ?5% (median OS 7.4 months (95% CI 6.27-10.01) vs. 9.9 months (95% CI 9.20-12.05); HR 2.37 (95% CI 1.64-3.42), P < 0.001); this was independent from other factors (stage, age, number of chemotherapy drugs, ECOG-PS), including response to therapy (supporting that %WLWeek4 impacted on OS regardless of response to therapy). Conclusion: In advanced PC treated with palliative chemotherapy, a %WLWeek4 ?5% was more prevalent in patients undergoing triplet chemotherapy, and was associated with shorter OS, regardless of response/progression to therapy. Early identification and intervention of weight loss seems to be key to improve patient outcomes.
    Citation
    Carnie L, Abraham M, McNamara MG, Hubner RA, Valle JW, Lamarca A. Impact on prognosis of early weight loss during palliative chemotherapy in patients diagnosed with advanced pancreatic cancer. Pancreatology. 2020.
    Journal
    Pancreatology
    URI
    http://hdl.handle.net/10541/623360
    DOI
    10.1016/j.pan.2020.09.012
    PubMed ID
    33046391
    Additional Links
    https://dx.doi.org/10.1016/j.pan.2020.09.012
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.pan.2020.09.012
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