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Chemotherapy dosing for cycle 1 in metastatic pancreatic cancer in routine practice
Background
Pancreatic cancer is the third most frequent type of gastrointestinal cancer in Europe and the fourth leading cause of death. Its diagnosis is usually late, as initial stages may be asymptomatic or with vague symptoms. Advanced stages may cause several debilitating symptoms that will impact on nutritional status. Weight loss and malnutrition are common and might impact on the chemotherapy dosage that the patient will receive with its potential final impact on prognosis. In fact, most antineoplastic drugs have a steep dose response relationship and a narrow therapeutic index. Small changes in dosing might produce severe adverse events or underdosing which may compromise outcomes. We carried out a retrospective review of our patients, to check the initial palliative chemotherapy dosage used in routine practice and the factors that lead to that decision.
Methods
Retrospective study of our population of stage IV pancreatic cancer patients at the beginning of palliative chemotherapy. We collected data about age, sex, ECOG PS when attending for cycle 1, % of weight loss in comparison with usual healthy weight, albumin levels, the presence of anorexia, the presence of diarrhoea, the use of supplemental drinks.
Results
We assessed 25 patients (13 males, 12 females) that attended to receive cycle 1 palliative chemotherapy. Median age was 56 (42-76). 8 received gemcitabine, 12 gemcitabine/abraxane, 5 gemcitabine/capecitabine. 18 (72%) had lost >10% of body weight in the prior 6 months, of which 5 continued to lose weight. 4 (16%) patients maintained good appetite and were able to eat an adequate diet. 21 patients had diarrhoea (84%), 9 patients daily diarrhoea ≥ 4 episodes; 12 with ≤ 3 episodes; 4 (16%) no diarrhoea. 22 (88%) patients were taking Creon and loperamide was recommended to those 21. All these patients were referred to the dieticians for further support. However, only 15 patients had been seen when attending for cycle 2. 18 (72%) had low albumin levels and all of them accepted supplemental drinks. ECOG PS was 0 (2 patients), 1 (18 patients), 2 (5 patients). In terms of dose received: full dose was given for cycle 1 to 4 patients, 20% dose reduction was administered to 16 patients. The 5 patients with ECOG 2 received a 30% dose reduction for cycle 1. When attending for cycle 2, 21 patients had experience clinical benefit or stabilisation of symptoms and 4 patients had clearly demonstrated further clinical deterioration.
Conclusions
Our study shows the relevance of nutritional status at the time of deciding the chemotherapy dosage for cycle one in metastatic pancreatic cancer patients. Diarrhoea and anorexia seem to be prevalent symptoms in this population and dietician support is needed. Hopefully more fine control could be achieved before starting them on chemotherapy, with a positive impact on dosage and potentially on benefit as well.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
