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.

Treating exocrine pancreatic cancer

Chemotherapy may be used at any stage of pancreatic cancer. It is commonly used in people with advanced cancer. Chemo may be used after the cancer has been removed with surgery to try to kill any cancer cells that may have been left behind (but can't be seen). This type of treatment is called adjuvant treatment. It is used to help stop the cancer from coming back later. In people who are expected to have surgery, chemo and radiotherapy may be given to shrink the tumor beforehand. When treatment is done before surgery it is called neoadjuvant treatment.

Gemcitabine (Gemzar^®) is the chemotherapy drug used most often to treat pancreatic cancer. Another commonly used drug is 5-fluorouracil (5-FU).

Sometimes, other drugs may be used along with gemcitabine or 5-FU, such as cisplatin, irinotecan (Camptosar^®, CPT-11), paclitaxel (Taxol^®), docetaxel (Taxotere^®), capecitabine (Xeloda^®), or oxaliplatin (Eloxitan^®).

Chemotherapy 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, and mouth sores. Because chemotherapy can damage the bone marrow, where new blood cells are made, blood cell counts might become low. This can result in:

• increased chance of infection (due to a shortage of white blood cells)
• bleeding or bruising after minor cuts or injuries (due to a shortage of platelets)
• fatigue and shortness of breath (due to low red blood cell counts)

Many of the chemotherapy 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 with 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: Newer drugs that target specific parts of cancer cells are now being studied. These drugs work differently from standard chemotherapy drugs, and they often have fewer side effects. (See "What's new in pancreatic cancer research and treatment?" for more information.)

A drug called erlotinib (Tarceva) has helped some patients with advanced pancreatic cancer. This drug is taken as a pill. 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 be slightly better than gemcitabine alone. Some people may get more benefit from this combination regimen than others. Common side effects of erlotinib include an acne-like rash, diarrhea, loss of appetite, and feeling tired.

Chemotherapy for pancreatic endocrine tumors

Chemotherapy (chemo) is not very helpful in treating these tumors, so it isn't often used. When chemo is used the preferred drugs are doxorubicin (Adriamycin^® and streptozocin. Recently, a special form of doxorubicin known as liposomal doxorubicin (Doxyl^®) has been used instead of the regular drug. In the newer 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, and temozolomide. Some recent studies have found that combining temozolomide with thalidomide or with capecitabine (Xeloda^®) can be helpful.

Targeted therapy: the drug sunitinib (Sutent) blocks a signal that tells cancer cells to grow and divide. When used to treat patients with pancreatic endocrine tumors that had spread outside of the pancreas, it caused some patients' tumors to shrink. It also helped many patients' tumors to stop growing.

Other drugs for treating pancreatic endocrine tumors

Octreotide is an agent chemically related to a natural hormone, somatostatin. It is very helpful for some patients with pancreatic endocrine tumors. It can stop the tumor from releasing its hormone into the blood stream. 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. Octreotide can help reduce diarrhea in patients with VIPomas, glucagonomas, and somatostatinomas. It also helps the rash of glucagonomas. This drug may even cause tumors to stop 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 (cholelithiasis). It can also result in insulin resistance that can make pre-existing diabetes more difficult to control.

This drug is available as a long-acting injection that needs to be given only once a month, which may help patients more than the short-acting version. A similar drug, lanreotide, 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: 10/13/2009
Last Revised: 10/13/2009