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.

When might chemotherapy be used?

Chemo is often part of the treatment for exocrine pancreatic cancer (the most common type of pancreatic cancer), but for pancreating neuroendocrine tumors (NETs), other types of medicines are used more often.

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, might lower 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, or if surgery isn’t an option for some other reason.

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

Which chemo drugs are used to treat pancreatic cancer?

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 can cause side effects. These depend on the type and dose of drugs given and how long treatment lasts. Common short-term side effects include:

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

Some chemo drugs can cause other side effects. For example:

• Drugs such as cisplatin, oxaliplatin, and paclitaxel can damage nerves, which can lead to symptoms of numbness, tingling, or even pain in the hands and feet (called peripheral neuropathy). For a day or so after treatment, oxaliplatin can cause nerve pain that gets worse with exposure to cold, including when swallowing cold foods or liquids.
• Cisplatin can damage the kidneys. Doctors try to prevent this 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.

Be sure to tell your doctor or nurse if you do have side effects, as there are often ways to help with them. For example, drugs can be given to prevent or reduce nausea and vomiting.

To learn more about chemo, see the Chemotherapy section of our website.

Targeted therapy for pancreatic cancer

As researchers have learned more about the changes in pancreatic cancer cells that help them grow, they have developed newer drugs to 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? for more information.)

Erlotinib (Tarceva) is a drug that targets a protein on cancer cells called EGFR, which normally helps the cells grow. In people with advanced pancreatic cancer, this drug can be given along with the chemo drug gemcitabine. Some people may benefit more from this combination than others. Common side effects of erlotinib include an acne-like rash on the face and neck, diarrhea, loss of appetite, and feeling tired.