Endothelial Progenitor Cells are Increased in Patients with Advanced Pancreatic Cancer Treated with Gemcitabine and Intravenous Omega 3 Compared with Controls

Introduction: Pancreatic adenocarcinoma (PAC) is a devastating disease. Endothelial progenitor cells (EPCs) are important mediators in PAC. Omega 3 fatty acids (ω-3FAs) have been shown to have anti-inflammatory properties. Methods: This was a single centre study investigating intravenous ω-3FAs and gemcitabine chemotherapy versus gemcitabine therapy alone in patients with APC. The primary outcome measure was the level of EPCs with the secondary outcome measure being the relationship between the EPC levels, progression free survival and overall survival. Results: Over the treatment period CD45 - , CD31 + , CD133 + EPCs and CD45 - , CD31 + , CD34 + EPCs significantly increased (P=O.O42 and P=0.0001), whilst no change was observed in control EPCs (P=0.705). There was a non-significant downward trend in control EPCs (P=0.930, 95%). There was a significant difference between the trial and control patients over time on logistic regression analysis (P=0.0001). There was a significant increase in CD45 - , CD34 + , CD31 + and CD133 + EPCs trial EPCs over treatment (P=0.007). There was no significant increase seen in control EPCs (P=0.358, 95%). There was a significant difference between the trial and control patients over treatment on logistic regression analysis (P=0.0001). There was a significant correlation in the trial patients between progression free survival benefit and an increase in EPCs. Conclusion: Intravenous ω-3FAs with gemcitabine chemotherapy in APC results in a significantly increased level of EPCs. There appears to be a survival benefit in patients with an increase in EPCs which may be the result of a reduction in pro-inflammatory mediators.