Gut microbiome and pancreatic cancer cachexia: An evolving relationship

Table 1 Consensus definitions of cancer cachexia[5]

Definition of cancer cachexia is met with one of the following
Weight loss > 5% over past 6 mo (in absence of simple starvation)
Body mass index < 20 and weight loss > 2%
Evidence of sarcopenia with weight loss > 2%1

¹Generally accepted measures of sarcopenia include: mid upper-arm muscle area by anthropometry (men < 32 cm², women < 18 cm²); appendicular skeletal muscle index determined by dual energy x-ray absorptiometry (men < 7.26 kg/m²; women < 5.45 kg/m²); lumbar skeletal muscle index determined by computed tomography imaging (men < 55 cm²/m²; women < 39 cm²/m²); whole body fat-free mass index without bone determined by bioelectrical impedance (men < 14.6 kg/m²; women < 11.4 kg/m²).

Table 2 Key outcome measures in cachectic patients with advanced pancreatic cancer over 12 wk of enteral feeding

Outcome (n = 16)	Change (SD)
Average weight (kg)	+1.29 (5.8)
Body mass index (kg/m2)	+0.6 (1.7)
% Body fat	-1.6 (5)
Bone mineral density (T-score)	-0.01 (0.02)
Body fat mass (g)	-602 (2794)
Lean body mass (g)	+1273.1 (4078)
Appendicular lean mass (kg/m2)	+0.45 (0.62)
C-reactive protein (mg/mL)	-9.77 (SE 11.6)
Patient-reported outcomes
NIH PROMIS (mean difference in score)
Pain interference	-7.5 (P = 0.05)
Fatigue	-7.1 (P = 0.06)
Depression	-10.4 (P = 0.006)
EORTC QLQ-C30 (mean difference in score)
Global health	+13.3 (P = 0.05)

Table 3 Gut microbiome compositional changes in patients with advanced pancreatic cancer receiving 12 wk of enteral feeding for cachexia

Stool microbiome assessment1	Outcome
Relative abundance from baseline (time 0) to 12 wk (n = 6)	Increased abundance: Veillonella genera (P = 0.015); Actinomyces genera (P = 0.039). Decreased abundance: Bacteroides genera (P = 0.015); Butyricicoccus genera (P = 0.039)
Relative abundance in baseline stool samples from subjects achieving weight stability (n = 8)	Increased abundance: Veillonella genera (P = 0.0006). Decreased abundance: Bifidobacterium genera (P = 2.35 × 10-5)2
Diversity indices (n = 8)	Weight stability associated with reduced diversity by Chao1 index of richness (P = 0.0208) but not reduced species richness and evenness by Shannon index (P = 0.187)

¹Performed through 16S ribosomal RNA gene sequencing.

²Taxa summary plot suggested that this finding was driven by a high percentage of this bacterium in one patient who had a much higher overall survival than the mean.