Expert opinion on management of pancreatic exocrine insufficiency in pancreatic cancer.

Pancreatic exocrine insufficiency (PEI) is a common condition in patients with pancreatic cancer (PC). PEI can be due to the tumor, which, if located in the head, causes obstruction of the pancreatic duct with subsequent atrophy of the pancreatic parenchyma, or it can be the consequence of pancreatic surgical resection. The standard treatment of PEI is pancreatic enzyme replacement therapy (PERT). Clinical data to support the use of PERT in PC are however limited. There are very few randomized clinical trials that evaluated PERT in PC. Most data come from observational studies. Despite this limited clinical evidence, PERT treatment for PEI is an essential part of supportive therapy to ensure optimal nutritional status in PC patients who will receive surgery, neoadjuvant/adjuvant or palliative treatment. The objective of this review is to increase the awareness about PEI in PC patients and to provide expert recommendations on the use of PERT in resected, borderline resectable and unresectable patients, based on clinical experience and literature review.

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Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Disclosure IB: Grants or contracts from any entity: Servier. Payment or honoraria for lectures, presentations, speaker’s bureaus, manuscript writing or educational events: Servier, Bayer, Taiho, Ipsen, Guerbet. Support for attending meetings and/or travel: Ipsen. Participation on a Data Safety Monitoring Board or Advisory Board: FFCD. GR: All support for the present manuscript: Medical writing—Corina Schmidt. Payment for expert testimony: Participation in advisory board meeting organized by Viatris, payment to institution. KG: All support for the present manuscript: Medical writing—Viatris. Grants or contracts from any entity: Ipsen, Pfizer, Bayer. Consulting fees: Viatris: adboard on pancreatic cancer, paid to institution. Participation on a Data Safety Monitoring Board or Advisory Board: BMS, Servier, Lily, paid to institution. MP: Consulting fees: Viatris. FB: All support for the present manuscript: Medical writing—Viatris. Consulting fees: Viatris. EVC: Grants or contracts from any entity: Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Ipsen, Lilly, Merck Sharp & Dohme, Merck KGaA, Novartis, Roche, Servier, paid to institution. Consulting fees: Abbvie, Array, Astellas, Astrazeneca, Bayer, Beigene, Biocartis, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Daiichi, Halozyme, GSK, Helsinn, Incyte, Ipsen, Janssen Research, Lilly, Merck Sharp & Dohme, Merck KGaA, Mirati, Novartis, Pierre Fabre, Roche, Seattle Genetics, Servier, Sirtex, Terumo, Taiho, TRIGR, Zymeworks. The remaining authors have declared no conflicts of interest