Pancreatic Cancer

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Treating Pancreatic Cancer TOPICS

Chemotherapy for pancreatic cancer

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

Chemotherapy for exocrine pancreatic cancer

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

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

Gemcitabine (Gemzar®) is the chemo drug used most often to treat pancreatic cancer. It is sometimes combined with the drug albumin-bound paclitaxel (Abraxane®, nab-paclitaxel). Another commonly used drug is 5-fluorouracil (5-FU). It may be combined with a number of other chemo drugs, such as irinotecan (Camptosar®, CPT-11) and oxaliplatin (Eloxitan®), as well as the vitamin-like drug folinic acid (leucovorin).

Sometimes, other drugs may be used as well, such as cisplatin, paclitaxel (Taxol®), docetaxel (Taxotere®), and capecitabine (Xeloda®).

Chemo drugs kill cancer cells but also damage some normal cells. 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:

  • Nausea and vomiting
  • Loss of appetite
  • Hair loss
  • Mouth sores
  • Diarrhea

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

Targeted therapy for exocrine pancreatic cancers

As researchers have learned more about the gene changes in cells that cause cancer, they have been able to develop newer drugs that specifically target these changes. These drugs are often referred to as targeted therapy. They work differently from standard chemotherapy drugs and often have different (and less severe) side effects. (See “What's new in pancreatic cancer research and treatment?” for more information.)

A pill called erlotinib (Tarceva®) has helped some patients with advanced pancreatic cancer. Erlotinib targets a protein on the surface of cancer cells called EGFR, which normally prompts cancer cells to grow. When combined with gemcitabine, it has been shown to work slightly better than 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. When chemo is used the preferred drugs 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 have been 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

The drug sunitinib (Sutent®) attacks both blood vessel growth and other targets that stimulate cancer cell growth. When used to treat patients with PNETs with spread outside of the pancreas, it has been shown to slow tumor growth and help patients live longer. This drug is a pill that is taken once a day to treat pancreatic NETs. 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. This drug is approved by the FDA to treat PNETs that cannot be removed with surgery or have spread outside the pancreas.

Everolimus (Afinitor®) works by blocking a cell protein known as mTOR, which normally promotes cell growth and division. When used to treat patients with PNETs that have spread outside of the pancreas, it has been shown to slow tumor growth. It's not yet clear if this drug helps patients live longer. Everolimus is a pill taken once a day to treat PNETs. Common side effects of this drug include mouth sores, an increased risk of 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. This drug is approved by the FDA to treat PNETs that cannot be removed with surgery or have spread outside the pancreas.

Other drugs for treating pancreatic neuroendocrine tumors

Somatostatin analogs: Octreotide (Sandostatin®) is an agent chemically related to a natural hormone, somatostatin. It is very helpful for some patients with PNETs. It can stop the tumor from releasing its hormone into the bloodstream. This reduces symptoms and helps patients feel better. This drug 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.)

Octreotide can help reduce diarrhea in patients with VIPomas, glucagonomas, and somatostatinomas. It also helps the rash of glucagonomas. This drug may even stop tumors from growing. The main side effects are pain at the site of the injection, and rarely, stomach cramps, nausea, vomiting, headaches, dizziness, and fatigue. Octreotide causes sludging of bile in the gallbladder which can lead to gallstones. It can also make the body resistant to the action of insulin, making pre-existing diabetes more difficult to control. This drug is not often used in treating insulinomas, because its effects on the release of other hormones can cause worse problems with blood sugars.

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. A similar drug, lanreotide (Somatuline® Depot), is also available. It is also given as an injection once a month. A newer drug called pasireotide is currently being studied.

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

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

Last Medical Review: 01/28/2013
Last Revised: 02/05/2014