Effects of Alkalization Therapy on Chemotherapy Outcomes in Advanced Pancreatic Cancer: A Retrospective Case-Control Study

Background/Aim: Neutralization of the acidic tumor microenvironment, which is associated with both progression and drug resistance of cancer cells, may be a new treatment option for progressing forms of cancer. We conducted a case-control study to investigate the effects of alkalization therapy, consisting of an alkaline diet with supplementary oral sodium bicarbonate, in patients with metastatic or recurrent pancreatic cancer (study registration no.: UMIN000036126). Patients and Methods: Thirty-six patients in the alkalization group (Karasuma Wada Clinic; alkalization therapy plus chemotherapy) were retrospectively compared to 89 patients in the control group (Kyoto University Hospital; chemotherapy only). Results: The median overall survival (OS) in the alkalization group was significantly longer than that in the control group (15.4 vs. 10.8 months; p<0.005). In the alkalization group, mean urine pH was significantly increased after alkalization therapy 16.38 +/- 0.85 (before) vs. 6.80 +/- 0.71 (after); p<0.05]. Furthermore, the median OS of patients with increased urine pH (pH>7.0 or Delta pH>1 .0) in the alkalization group was significantly longer than that of the control group. Conclusion: Alkalization therapy may enhance the effects of chemotherapy in patients with advanced pancreatic cancer.