Chemotherapy for Pancreatic Cancer

Chemotherapy (chemo) is an anti-cancer drug injected into a vein or taken by mouth. These drugs enter the bloodstream and reach almost all areas of the body, making this treatment potentially useful for cancers whether or not they have spread.

When might chemotherapy be used?

Chemo is often part of the treatment for pancreatic cancer and may be used at any stage:

• Before surgery (neoadjuvant chemotherapy): Chemo can be given before surgery (sometimes along with radiation) to try to shrink the tumor so it can be removed with less extensive surgery. Neoadjuvant chemo is often used to treat cancers that are too big to be removed by surgery at the time of diagnosis (called locally advanced cancers).
• After surgery (adjuvant chemotherapy): Chemo can be used after surgery (sometimes along with radiation) to try to kill any cancer cells that have been left behind or have spread but can’t be seen, even on imaging tests. If these cells were allowed to grow, they could form new tumors in other places in the body. This type of treatment might lower the chance that the cancer will come back later.
• For advanced pancreatic cancer: Chemo can be used when the cancer is advanced and can’t be removed completely with surgery, or if surgery isn’t an option, or if the cancer has spread to other organs.

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

Which chemo drugs are used for pancreatic cancer?

In most cases (especially as adjuvant or neoadjuvant treatment), chemo is most effective when 2 or more drugs are given together. For people who are not healthy enough for combined treatments, a single drug (usually gemcitabine, 5-FU, or capecitabine) can be used.

The most common drugs used for both adjuvant and neoadjuvant chemo include:

• Gemcitabine
• 5-fluorouracil (5-FU)
• Oxaliplatin
• Albumin-bound paclitaxel (Abraxane)
• Capecitabine (an oral 5-FU drug)
• Cisplatin
• Irinotecan

Chemotherapy for advanced pancreatic cancer

• Gemcitabine
• 5-fluorouracil (5-FU) or capecitabine (an oral 5-FU drug)
• Irinotecan or liposomal irinotecan (Onivyde)
• Platinum drugs: cisplatin or oxaliplatin
• Taxanes: paclitaxel, docetaxel, or albumin-bound paclitaxel (Abraxane)

How is chemotherapy given?

Chemo drugs for pancreatic cancer can be given into a vein (IV) or by mouth as a pill. The infusion can be done in a doctor’s office, chemotherapy clinic, or in a hospital.

Often, slightly larger and sturdier IV lines are required to give chemo. These are known as central venous catheters (CVCs), central venous access devices (CVADs), or central lines. They are used to put medicines, blood products, nutrients, or fluids into your blood. They can also be used to take out blood for testing.

Doctors give chemo in cycles, with each period of treatment followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often 2 or 3 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.

Adjuvant and neoadjuvant chemo is often given for a total of 3 to 6 months, depending on the drugs used. The length of treatment for advanced pancreatic cancer is based on how well it is working and what side effects you have.

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 possible side effects include:

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

Chemo can also affect the blood-forming cells of the bone marrow, which can lead to:

• Increased chance of infection (from a shortage of white blood cells)
• Bleeding or bruising (from a shortage of platelets)
• Fatigue or shortness of breath (from having too few red blood cells)

These side effects usually go away after treatment. There are often ways to lessen these side effects. For example, drugs can be given to help prevent or reduce nausea and vomiting.

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 intravenous (IV) fluids before and after the drug is given.
• Cisplatin can affect hearing. Your doctor may ask if you have any ringing in the ears or hearing loss during treatment.