Supportive Care in Cancer

, Volume 25, Issue 6, pp 1963–1971

Treatment of pancreatic insufficiency using pancreatic extract in patients with advanced pancreatic cancer: a pilot study (PICNIC)

  • Nicholas Zdenkowski
  • George Radvan
  • Leanna Pugliese
  • Julie Charlton
  • Christopher Oldmeadow
  • Allison Fraser
  • Antonino Bonaventura
Original Article

DOI: 10.1007/s00520-017-3602-2

Cite this article as:
Zdenkowski, N., Radvan, G., Pugliese, L. et al. Support Care Cancer (2017) 25: 1963. doi:10.1007/s00520-017-3602-2



Survival with advanced pancreatic cancer is less than 12 months. Pancreatic exocrine insufficiency may contribute to pancreatic cancer-related cachexia, via nutrient malabsorption. We aimed to determine the feasibility of prescribing pancreatic extract (Creon®) for patients with advanced pancreatic cancer.


Patients with advanced pancreatic cancer, without frank malabsorption, were randomised in this feasibility study to pancreatic extract 50,000 units with meals and 25,000 units with snacks, or placebo. Standardised dietary advice was given. Anti-cancer and supportive care treatments were permitted. Outcomes included weight, body mass index (BMI), quality of life (QLQC30, PAN26), survival and nutritional assessment (PG-SGA).


Eighteen patients were randomised before study closure due to slow recruitment. Baseline characteristics were well matched. Weight loss prior to randomisation was numerically greater in the pancreatic extract group (mean 0.7 vs 2.2 kg). Weight loss was numerically greater in the placebo group, however not significantly. No differences in BMI or nutrition score were seen. Quality of life did not differ between study groups. Median overall survival was 17 (95% CI 8.1–48.7) weeks in the control group, and 67.6 (95% CI 14.1–98.4) weeks in the pancreatic extract group (p = 0.1063). Only 17% (18/106) of potentially eligible patients were recruited, related to patient/family reluctance, rapid clinical deterioration and patients already prescribed pancreatic extract. A moderate pill burden was noted.


Despite intriguing survival results, this study was not sufficiently feasible to proceed to a fully powered comparative study. A multi-centre study would be required to exclude a significant difference in outcomes.


Pancreatic insufficiency Cachexia Malabsorption Pancreatic cancer 

Funding information

Funder NameGrant NumberFunding Note
Hunter New England Local Health District
    Calvary Mater Newcastle

      Copyright information

      © Springer-Verlag Berlin Heidelberg 2017

      Authors and Affiliations

      1. 1.Department of Medical OncologyCalvary Mater Newcastle HospitalWaratahAustralia
      2. 2.School of Medicine and Public HealthUniversity of NewcastleCallaghanAustralia
      3. 3.Pharmacy DepartmentCalvary Mater Newcastle HospitalWaratahAustralia
      4. 4.Newcastle Private HospitalNew Lambton HeightsAustralia
      5. 5.Hunter Medical Research InstituteNew LambtonAustralia
      6. 6.Department of DieteticsCalvary Mater Newcastle HospitalWaratahAustralia

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