Chemotherapy for Pancreatic Neuroendocrine Tumors (pNETs)

Chemo is most often used to treat pancreatic neuroendocrine tumors (pNETs) if they:

• Have not responded to other medicines (such as somatostatin drugs or targeted therapy)
• Have spread to other organs
• Are large or growing quickly
• Are causing severe symptoms, or
• Are high grade (grade 3)

How chemotherapy for pancreatic neuroendocrine tumors (pNETs) works

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

Chemo drugs can be given alone or combined with another chemo drug. The most used drugs for pNETs include:

• Temozolomide (Temodar)
• Capecitabine (Xeloda)
• Oxaliplatin (Eloxatin)
• Fluorouracil (5-FU)
• Cisplatin or Carboplatin
• Etoposide (VePesid)
• Irinotecan (Camptosar)

How is chemotherapy given for pNETs?

Chemo drugs may be given in different ways, such as by mouth or by vein (intravenous, IV).

When chemo is a pill or capsule, usually you can take it at home. Your care team may give you a calendar showing which day to take the pills and how many to take. Your doctor will want to see you frequently to make sure you are doing well while you take the treatment at home.

When the chemo is given by vein, it is as an injection over a few minutes or infusion over a longer period. This can be done in a doctor’s office, chemotherapy clinic, or in a hospital setting.

In general, chemo is given in cycles, which includes a period of treatment followed by a rest period to give you time to recover from the effects of the drugs. Each cycle of chemo can range from 2 to 6 weeks. 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.

The length of treatment for advanced pNETs is based on how well it is working and what side effects you have.

Possible side effects of chemotherapy for pNETs

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, which can lead to side effects.

The side effects of chemo depend on the type and dose of drugs given and the length of time they are taken. Common side effects can include:

• Nausea and vomiting
• Diarrhea or constipation
• Loss of appetite
• Hair loss
• Mouth sores
• Skin rashes
• Fatigue (from having too few red blood cells)
• Increased chance of infections (from having too few white blood cells)
• Easy bruising or bleeding (from having too few blood platelets)

Most side effects go away after treatment is finished. Tell your cancer care team about any side effects or changes you notice while getting chemotherapy, so that they can be treated right away. Often, medicines can help prevent or minimize many of the side effects. For example, your doctor can prescribe drugs to help prevent or reduce nausea and vomiting. In some cases, the doses of the chemo drugs might need to be lowered or treatment might need to be delayed or stopped to keep the effects from getting worse.