Chemotherapy and
radiotherapy offer little benefit to patients with advanced
pancreatic cancer.
Eicosapentaenoic acid (EPA) has anticancer effects both in vitro and in animal models. The dose of EPA that can be administered to
cancer patients has previously been limited by the low purity of available preparations and the tolerability of large capsules. A high-purity preparation of EPA as a 20% oil-in-water diester
emulsion allowed a small study of the tolerance, incorporation, and effects of EPA in high doses in five patients with advanced
pancreatic cancer. Patients underwent assessment at baseline and every 4 wk thereafter. All patients managed to tolerate a dose providing 18 g EPA per day, with doses between 9 and 27 g daily being taken for at least a month. Dosage was limited by a sensation of fullness, cramping
abdominal pain,
steatorrhea, and
nausea. All such symptoms were controlled by
dose reduction or pancreatic
enzyme supplements. No other adverse effects attributable to the trial agent were observed. Plasma
phospholipid EPA content increased from around 1% at baseline to 10% at 4 wk and 20% at 8 wk. Incorporation of EPA into red blood cell
phospholipids reached levels of around 10%. The present study has shown that a novel, high-purity, EPA diester
emulsion can be tolerated at a dose providing around 18 g EPA per day with side-effects being easily controlled. The acceptibility of large doses of oral EPA should allow larger controlled clinical studies into potential anticancer effects of EPA.