Guidelines Needed for PERT Use in Individuals With EPI, Pancreatic Cancer

Few surgeons think that pancreatic enzyme replacement therapy (PERT) improves survival in patients with resectable pancreatic cancer and exocrine pancreatic insufficiency (EPI), despite being widely prescribed in these patients.

To determine how PERT is used in this patient population in a real-world setting, the researchers surveyed pancreatic surgeons about their use of PERT. To do so, the researchers distributed an online survey to members of The Americas Hepato-Pancreato-Biliary Association (AHPBA) and The Pancreas Club.

Results indicated that 180 of the 208 surgeons who had responded to the survey (86.5%) prescribe PERT for at least some of their patients whose pancreatic cancer is resectable or borderline resectable. However, 28.1% of surveyed surgeons typically order tests to confirm EPI before initiating PERT or order testing to determine the adequacy of PERT. Moreover, only 1 in 5 of the surgeons (19.7%) surveyed think that PERT affects overall survival and even fewer (6.0%) think it affects disease-free survival in patients with pancreatic cancer.

These findings led the researchers to conclude that although PERT is typically prescribed for patients whose pancreatic cancer is resectable or borderline resectable, testing to confirm the presence of exocrine pancreatic insufficiency or to assess its adequacy is poorly used, and a considerable proportion of surgeons question the effect of pancreatic enzyme replacement therapy on survival in patients with pancreatic cancer.

“These data call for prospective studies to establish guidelines for optimal use of PERT and its effects on survival outcomes in [patients with pancreatic cancer],” the researchers concluded.

—Ellen Kurek

Reference:

Jain T, Sharma P, Giri B, et al. Prescription patterns of pancreatic enzyme replacement therapy for patients with pancreatic cancer in the United States. HPB (Oxford). Published online May 23, 2022. doi:10.1016/j.hpb.2022.05.003