S226 The Use of Pancreatic Enzyme Replacement Therapy During Chemotherapy for Pancreatic Cancer: A Retrospective Cross-Sectional Study

Introduction: Pancreatic cancer (PC) is a devastating diagnosis, often presenting at an advanced stage. Pancreatic exocrine insufficiency (PEI) is commonly associated, due to tissue destruction, Wirsung duct occlusion and surgical resection. PEI can be easily overlooked amidst the shock and overlapping symptoms with advanced cancer or the side effects of chemotherapy. Pancreatic enzyme replacement therapy (PERT) has proven to be beneficial during chemotherapy. The study objectives are to determine the use of PERT during chemotherapy and possible associations with outcomes. Methods: A retrospective cross-sectional study was conducted at a Canadian university-affiliated regional oncology center. All medical records of patients initiating a chemotherapy regimen for PC between January 1, 2019, and September 30, 2023, were reviewed. Results: The study population included 100 PC patients with a median age of 68 years. Demographic data and clinical course are presented in Table 1 [Tables presented at ACG annual meeting]. Chemotherapy was administered in neoadjuvant, adjuvant, and palliative settings for 17, 19, and 64 patients, respectively. First-line regimens included FOLFIRINOX (39%), gemcitabine alone (40%), nab-paclitaxel-gemcitabine (20%), or other (1%). Twenty-five patients had a complete oncological resection, of which 5 had neoadjuvant chemotherapy. Thirty-six patients received a second-line regimen, and 12 received 3 or more regimens. PERT was prescribed in only 17% of patients with palliative chemotherapy, despite the majority (83%) having had signs of PEI (weight loss, diarrhea or obstructed Wirsung duct with dilatation). There were no significant differences associated with weight changes, number of cycles of chemotherapy, interruptions of regimen protocols, nor survival when comparing PERT status in the palliative group. The highest prevalence of PERT prescription (42%) was in the adjuvant chemotherapy group. No patients in the neoadjuvant group received PERT during chemotherapy. Conclusion: In this retrospective review of clinical practice patterns, PEI seems to be overlooked, and PERT is underutilized for PC patients during palliative and neoadjuvant chemotherapy. Barriers include uncertainties about the diagnostic approach of PEI, lack of awareness of PERT as nutritional adjunctive therapy and lack of patient education and a multidisciplinary approach. Future prospective studies should include PERT as an adjunct to neoadjuvant chemotherapy and formally measured symptoms of PEI.