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.
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.
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; multivariable Odds Ratio (vs monotherapy) = 3.25; 95% CI 1.40–7.56; p-value 0.006 vs. 19.3% (doublet) vs 14.1% (monotherapy)].
Median OS was 9.7 months (95% CI 8.54–10.41). Multivariable Cox regression demonstrated shorter OS if %WLWeek4 ≥5% (median OS 7.4months (95% CI 6.27–10.01) vs. 9.9months (95% CI 9.20–12.05); HR 2.37 (95% CI 1.64–3.42), P < 0.001); independent from other factors (stage, age, number of chemotherapy drugs, ECOG-PS and response to therapy) supporting that %WLWeek4 impact lgregardless of response to therapy.
A %WLWeek4 ≥5% was more prevalent in patients undergoing triplet chemotherapy, and was associated with shorter OS, regardless of response to therapy.