Pancreatic Cancer

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Treating Pancreatic Cancer TOPICS

Chemotherapy and other drugs for pancreatic cancer

Chemotherapy (chemo) uses anti-cancer drugs injected into a vein or taken by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment potentially useful for cancers that have spread beyond the organ they started in.

Chemotherapy for exocrine pancreatic cancer

Chemo may be used at any stage of pancreatic cancer:

  • Chemo can be given before surgery (sometimes along with radiation) to try to shrink the tumor. This is known as neoadjuvant treatment.
  • Chemo can be used after surgery (sometimes along with radiation) to try to kill any cancer cells that have been left behind (but can’t be seen). This type of treatment, called adjuvant treatment, lowers the chance that the cancer will come back later.
  • Chemo is commonly used when the cancer is advanced and can’t be removed completely with surgery.

When chemo is given along with radiation, it is known as chemoradiation or chemoradiotherapy. It can help the radiation work better, but it also has more severe side effects.

Many different chemo drugs can be used to treat pancreatic cancer, including:

  • Gemcitabine (Gemzar®)
  • 5-fluorouracil (5-FU)
  • Irinotecan (Camptosar®)
  • Oxaliplatin (Eloxatin®)
  • Albumin-bound paclitaxel (Abraxane®)
  • Capecitabine (Xeloda®)
  • Cisplatin
  • Paclitaxel (Taxol®)
  • Docetaxel (Taxotere®)
  • Irinotecan liposome (Onivyde®)

In people who are healthy enough, 2 or more drugs are usually given together. For people who are not healthy enough for combined treatments, a single drug (usually gemcitabine, 5-FU, or capecitabine) can be used.

Doctors give chemo in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Each chemo cycle typically lasts for a few weeks.

Possible side effects

Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemo. This can lead to side effects, which depend on the type of drugs, the amount taken, and the length of treatment. Common short-term side effects include:

Because chemo can damage bone marrow, where new blood cells are made, blood cell counts might become low. This can result in:

  • Increased chance of infection (from a shortage of white blood cells)
  • Bleeding or bruising after minor cuts or injuries (from a shortage of platelets)
  • Fatigue and shortness of breath (from too few red blood cells)

Many of the chemo drugs used for pancreatic cancer can cause diarrhea.

Other side effects can occur depending on what chemo drugs are used. For example:

  • Drugs such as cisplatin, oxaliplatin, and albumin-bound paclitaxel can cause nerve damage (called neuropathy). This can lead to symptoms of numbness, tingling, or even pain in the hands and feet. For a day or so after treatment, oxaliplatin can cause nerve pain that gets worse with exposure to cold. This often causes pain when swallowing that is worse when trying to swallow cold foods or liquids.
  • Cisplatin can cause kidney damage (called nephropathy). Doctors try to prevent this problem by giving the patient lots of fluid before and after the drug is given.

If you will be getting chemo, ask your cancer care team about the drugs being used and what side effects to expect.

Most side effects go away once treatment is stopped. If you do have side effects, there are often treatments that can help reduce them or make them go away. For example, drugs can be given to prevent or reduce nausea and vomiting.

For more information about chemo, please see the Chemotherapy section of our website, or our document A Guide to Chemotherapy.

Targeted therapy for exocrine pancreatic cancers

As researchers have learned more about the changes in cells that cause cancer, they have developed newer drugs that specifically target these changes. These targeted drugs work differently from standard chemo drugs. Sometimes they work when standard chemo drugs don’t, and they often have different (and less severe) side effects. (See “What’s new in pancreatic cancer research and treatment?” for more information.)

Erlotinib (Tarceva®) is a drug that targets a protein on the surface of cancer cells called EGFR, which normally prompts cancer cells to grow. This drug can help some patients with advanced pancreatic cancer. People given erlotinib combined with the chemo drug gemcitabine tend to do slightly better than those who get gemcitabine alone. Some people may benefit more from this combination than others. Common side effects of erlotinib include an acne-like rash, diarrhea, loss of appetite, and feeling tired.

Chemotherapy for pancreatic neuroendocrine tumors

Chemo is not often very helpful in treating these tumors, so it isn’t often used. As with exocrine pancreatic cancers, when chemo is used it often includes a combination of 2 or more drugs.

The most commonly used drugs for pancreatic NETs are doxorubicin (Adriamycin®) and streptozocin. Sometimes a special form of doxorubicin known as liposomal doxorubicin (Doxil®) has been used instead of the regular drug. In this form, the drug is dissolved in fat droplets, which allows it to be given with less serious side effects.

Other chemo drugs that might be helpful in treating these tumors include fluorouracil (5-FU), dacarbazine (DTIC), and temozolomide (Temodar®). Some recent studies have found that combining temozolomide with thalidomide or with capecitabine (Xeloda) can be helpful.

Targeted therapy for pancreatic neuroendocrine tumors

Some targeted drugs can be helpful in treating advanced pancreatic NETs.

Sunitinib (Sutent®) attacks both blood vessel growth and other targets that help cancer cells grow. In advanced pancreatic NETs, it has been shown to slow tumor growth and help patients live longer. This drug is taken as pills once a day. The most common side effects are nausea, diarrhea, changes in skin or hair color, mouth sores, weakness, and low blood cell counts. Other possible effects include tiredness, high blood pressure, heart problems, bleeding, hand-foot syndrome (redness, pain, and skin peeling of the palms of the hands and the soles of the feet), and low thyroid hormone levels.

Everolimus (Afinitor®) works by blocking a cell protein known as mTOR, which normally helps cells grow and divide. This drug has been shown to slow tumor growth, but it’s not yet clear if it helps patients live longer. Everolimus is a pill taken once a day. Common side effects of this drug include mouth sores, infections, nausea, loss of appetite, diarrhea, skin rash, feeling tired or weak, fluid buildup (usually in the legs), and increases in blood sugar and cholesterol levels. A less common but serious side effect is damage to the lungs, which can cause shortness of breath or other problems.

Other drugs for treating pancreatic neuroendocrine tumors

Other types of drugs are sometimes useful in treating people with pancreatic NETs as well.

Somatostatin analogs: Drugs that are chemically related to somatostatin, a natural hormone in the body, can be very helpful for some patients with pancreatic NETs. They stop tumors from releasing hormones into the bloodstream, which can often relieve symptoms and help patients feel better. They also seem to help slow the growth of some tumors. These drugs can be expected to help anyone with a tumor that can be seen on somatostatin receptor scintigraphy (see “Imaging tests” in the “How is pancreatic cancer diagnosed?” section).

These drugs can help reduce diarrhea in patients with VIPomas, glucagonomas, and somatostatinomas, and can also help the rash of glucagonomas.

The main side effects are pain at the site of the injection, and rarely, stomach cramps, nausea, vomiting, headaches, dizziness, and fatigue. These drugs can also cause sludge to build up in the gallbladder, which can lead to gallstones. They can also make the body resistant to the action of insulin, which can raise blood sugar levels and make pre-existing diabetes harder to control. These drugs are not often used in treating insulinomas, because the effects on the release of other hormones can cause worse problems with blood sugars.

Octreotide (Sandostatin®) was the first somatostatin analog to become available. The standard version of octreotide is short-acting and is given as an injection 2 to 4 times a day. This drug is also available in a long-acting form (called Sandostatin LAR Depot) that only needs to be given once a month, which may help patients more than the short-acting version.

Lanreotide (Somatuline® Depot), a newer somatostatin analog, is given as an injection under the skin about once a month. It has been shown to help slow the growth of pancreatic NETs.

Pasireotide (Signifor®, Signifor® LAR), another newer somatostatin, is injected either twice a day or about once a month. This drug is also being studied for use in pancreatic NETs.

Diazoxide: This drug can block insulin release from the pancreas. It can be used to prevent low blood sugar (hypoglycemia) in patients with insulinomas. This drug is often used before surgery, to make the operation safer for the patient.

Proton pump inhibitors: These drugs block acid secretion from the stomach. They are often very helpful in preventing ulcers in patients with gastrinomas, although they might need to be taken in higher than usual doses. Examples of these drugs include omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), and others.

To learn more about a drug mentioned in this section, or any specific drug you’re taking for cancer, call us at 1-800-227-2345 or visit our Cancer Drug Guide online.

Last Medical Review: 06/11/2014
Last Revised: 10/22/2015