Abstract 6642: Metabolic predictors of chemotherapy response in pancreatic cancer.

Abstract INTRODUCTION: Chemotherapy response in pancreatic cancer (PC) varies and is monitored by CA 19-9. Since PC is linked to metabolic dysregulation, this study evaluates how patient baseline metabolic status (glucose, HbA1c, and BMI) relates to the longitudinal trend of CA 19-9 over six months in non-surgical PC patients. METHODS: A TriNetX-based study design was employed to analyze longitudinal CA 19-9 trends over six months (representing the optimal chemotherapy response window) in PC patients who did not undergo surgical intervention. Patients were categorized into distinct strata based on (1) glucose levels: 150 mg/dL, 150-250 mg/dL, 251-350 mg/dL; (2) HbA1c levels: 7%, 7-10%, 10%-13.5%; and (3) BMI ranges: 20-25, 25-30, 30-35, 35-40. RESULTS: For Glucose: Baseline CA 19-9 levels correlated positively with increasing glucose strata. Only the highest glucose group (251-350 mg/dL) showed a statistically significant CA 19-9 reduction during chemotherapy (p0.05). Significant differences emerged when comparing this group to both lower groups (p0.05). Across disease stages, higher glucose levels were consistently associated with greater CA 19-9 declines, indicating enhanced chemotherapy response. This association was most pronounced in locally advanced stages (2,3). For HbA1c: Baseline CA 19-9 values were lower in the high HbA1c group (10%-13.5%). Although within-group declines were not significant, between-group comparisons at six months indicated a significantly greater CA 19-9 reduction in the highest HbA1c group compared with both the 7% and 7-10% groups (p0.05). For BMI: Baseline CA 19-9 levels did not differ across groups. During treatment, only the highest BMI group (35-40) demonstrated a significant decline in CA 19-9 (p0.05), while lower BMI groups (20-35) did not. Patients with BMI 35-40 responded more favorably compared with lower BMI categories (p0.05). CONCLUSION: This study demonstrates that baseline metabolic factors modulate chemotherapy response in non-surgical PC patients. Higher glucose and BMI, as well as elevated HbA1c, were associated with greater CA 19-9 declines during chemotherapy, suggesting that metabolic status may influence treatment efficacy. These findings highlight the need for further studies and supportive metabolic interventions to optimize chemotherapy outcomes in pancreatic cancer. Citation Format: Parnian Naji, Jordan Winter, . Metabolic predictors of chemotherapy response in pancreatic cancer abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 6642.