Evaluating Weight Stability of Pancreatic Cancer Cachexia Patients

In this study, we will prospectively evaluate advanced pancreatic adenocarcinoma patients with cachexia, who are receiving enteral feeding, with a peptide based diet (medical food), through a jejunal or gastrojejunal feeding tube. We plan to collect serum samples routinely and establish a cohort of patients with this clinical syndrome. Our aims are to establish the feasibility and efficacy of enteral nutrition and its relationship to meaningful clinical outcomes. Furthermore, we will assess for a correlation between cachexia, activity, and patient reported outcomes on domains of quality of life in an optional activity tracker sub-study.

• Tube feeding (Other), also known as Enteral feeding, Jejunal tube, Gastrojejunal tube: Jejunal or gastrojejunal tube feeds will be given as continuous feeds via pump with Peptamen (medical food), at the patient's home, for the duration of the protocol and as directed by the nutritionist.

Primary outcomes

• Weight [Change from baseline at 3 months]

Secondary outcomes

• Change in lean body mass [Change from baseline at 3 months]: Measured by Dexa Scan
• Performance Status (ECOG) [Change from baseline at 3 months]
• Quality of Life (EORTC QLQ-C30) [Change from baseline at 3 months]
• Response to nutritional management [Change from baseline at 3 months]: Assessment based on tumor biomarkers during enteral feeding period
• Food intake assessment by 24-hour recall [Change from baseline at 3 months]
• Smell and taste alteration by questionnaire [Change from baseline at 3 months]
• Muscle strength using hand grip strength dynamometer [Change from baseline at 3 months]
• Survival [3 years]
• Activity - steps taken [Change from baseline at 3 months]: As tracked by Fitbit Charge HR biosensor
• Activity - number of stairs [Change from baseline at 3 months]: As tracked by Fitbit Charge HR biosensor
• Activity - sleep duration and interruptions [Change from baseline at 3 months]: As tracked by Fitbit Charge HR biosensor
• Activity - heart rate [Change from baseline at 3 months]: As tracked by Fitbit Charge HR biosensor
• Changes in microbiome analysis [Change from baseline at 3 months]: As measured by stool sample microbiome analysis

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Advanced or locally advanced pancreatic cancer patients (can include new or recurrent diagnosis) referred to SOCCI-CSMC for chemotherapy
* Cachexia defined as greater than 5% unexplained weight loss within 6 months prior to screening visit or consultation with medical oncologist
* Candidate for enteral feeding with Peptamen, a peptide based formula. Must have jejunal or gastrojejunal tube either previously placed or at least prior to Day 1 of study
* Age ≥ 18 years.
* ECOG performance status 0-2
* Greater than or equal to 3 month life expectancy
* Ability to understand and the willingness to sign a written informed consent
* May have received prior anti-cancer treatment, complete or partial resection of primary tumor
* Patients must be ambulatory and have access to a smart phone to participate in the activity tracker sub-study

Exclusion Criteria:

* Patients with known brain metastases should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events
* Malignant ascites requiring paracenteses
* Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
* Bowel obstruction, partial or total
* Pregnancy

• Andrew Hendifar, MD, Principal investigator, Cedars-Sinai Medical Center