Pancreatic enzyme replacement therapy influences survival in patients with incurable pancreatic cancer

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Abstract Introduction The majority of patients with pancreatic cancer suffer from non-curative disease with dismal prognosis already upon diagnosis. Recent data suggests improved survival for patients who receive pancreatic enzyme replacement therapy (PERT). The aim of this study was to investigate the use of PERT and its possible impact on overall survival (OS) in palliative pancreatic cancer patients. Methods All patients with unresectable pancreatic cancer between 2010 and 2019 were retrieved from the Swedish National Registry for Pancreatic and Periampullary Cancer. Data on PERT prescription and collection was acquired from the Swedish National Medical Products Agency. Patients with a survival > one month were included in analysis. Survival data were analyzed using adjusted Cox regression models and presented as Hazard Ratio (HR) for risk of death in the PERT group. Results In total 9420 patients with unresectable pancreatic cancer were identified. Among these, 6742 (50.6% women, median age 71 years) patients survived > one month after diagnosis. Median OS was 7 months (range 3–151). PERT prescription was collected by 3343 (49.6%) patients, the medicated group was significantly younger (70 versus 72 years, P = 0.001) and to a larger extent men (51.4 versus 48.6%, P < 0.001). Several factors influenced survival in the univariable calculation. Still, in the adjusted regression analysis PERT was associated with prolonged OS (HR 0.72, c.i. 0.69–0.76, P < 0.001). Discussion In this large retrospective cohort of patients with incurable pancreatic cancer less than 50% received PERT. The results strongly indicate an association between PERT and prolonged survival and supplementary medication should be considered for this group.

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