Chemotherapy for pancreatic cancer

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is one of the most commonly used treatments for pancreatic cancer.

Chemotherapy may be given:

  • after surgery to reduce the chance of the cancer coming back (adjuvant chemotherapy)
  • if surgery isn’t possible to shrink the cancer, to relieve symptoms and improve survival (palliative chemotherapy)
  • to shrink a cancer before surgery (neoadjuvant chemotherapy)
  • with radiotherapy (chemoradiation).

Some chemotherapy drugs are given as tablets, but some are given through a pump or as a drip or injection into a vein (intravenously).

Chemotherapy is usually given as several sessions of treatment. Most people can have their chemotherapy as an outpatient. Your doctor or nurse will explain which chemotherapy is best for you. They will also explain the possible side effects of the drugs.

Sometimes, you may have treatment as part of a cancer research trial.

Chemotherapy

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is one of the most commonly used treatments for pancreatic cancer.

Chemotherapy may be given:

  • after surgery to reduce the chance of the cancer coming back. This is called adjuvant chemotherapy.
  • if surgery isn’t possible to shrink the cancer, relieve symptoms and improve survival. This is called palliative chemotherapy.
  • to shrink a cancer before surgery. This is called neoadjuvant chemotherapy. This may be done as part of a clinical trial for pancreatic cancer.

Sometimes, chemotherapy is given with radiotherapy. This is known as chemoradiation. If it is given with radiotherapy before surgery, it is called neoadjuvant chemoradiation. This would usually be as part of a clinical trial. Your doctor or specialist nurse can give you more information about chemoradiation.

Some chemotherapy drugs are given as tablets, but most are given by injection into a vein (intravenously). Intravenous chemotherapy can be given:

  • into a fine tube (cannula) in a vein in your arm or hand
  • through a flexible plastic tube (central line) that sits in a vein just under your collarbone at the top of your chest
  • through a flexible plastic tube (PICC line) that goes into a large vein in the bend of your elbow
  • into an implantable port (portacath) that has an opening (port) under the skin on your chest or arm going into a vein.

Some types of chemotherapy are given through a small portable pump, which is attached to your line or port. A controlled amount of the drug is given into the bloodstream over a set period of time. This means that you can go home with the pump, and spend less time in hospital.

Whether chemotherapy is given as tablets or into a vein, the drugs are absorbed into the blood and carried all round the body. The chemotherapy then destroys cancer cells wherever they are in the body.

Chemotherapy is usually given as several sessions of treatment. Each treatment is followed by a rest period of a week or two to allow your body to recover from any side effects. The treatment and the rest period together make up a cycle of treatment. The number of cycles you have will depend on the drugs that are used, and how well the treatment is working. This is checked by your doctor at regular appointments.

Most people can have their chemotherapy as an outpatient.

Three months after surgery I started chemotherapy. I did not feel ready or strong enough and on the first day of treatment I felt really nervous and anxious but it passed quickly enough and it wasn’t as bad as my imagination had led me to believe.

Carol


Chemotherapy after surgery

If you’re having chemotherapy after surgery to remove the cancer, the treatment will usually last for about six months.

The chemotherapy drug that’s most commonly used for cancer of the pancreas is gemcitabine (Gemzar®). It is given as a drip into a vein (intravenous infusion) over 30 minutes.

Gemcitabine is usually given once a week for three weeks followed by a rest every fourth week. These four weeks make up a cycle of treatment and you will usually have six cycles of treatment.

Another drug that may be used after surgery is fluorouracil (5FU). It is given intravenously or as tablets. The fluorouracil tablet is called capecitabine.


Chemotherapy for advanced pancreatic cancer

Gemcitabine is sometimes used in advanced pancreatic cancer. It can be given on its own or with another chemotherapy drug. This may be capecitabine or another drug called paclitaxel albumin (Abraxane®). Your doctor will talk to you about what drugs are available and suitable for you.

Gemcitabine and paclitaxel albumin (Abraxane®)

Gemcitabine may be given with another chemotherapy drug called paclitaxel albumin. Paclitaxel albumin is given as a drip into a vein, usually over half an hour. Like gemcitabine, it will usually be given once a week for three weeks, followed by a rest every fourth week. These four weeks make up a cycle of treatment. Your doctor or nurse will tell you more about this and the number of cycles of gemcitabine and paclitaxel albumin you are likely to have.

FOLFIRINOX

Sometimes, a combination of drugs called FOLFIRINOX may be given. It is made up of folinic acid (leucovorin) and the chemotherapy drugs fluorouracil (5FU), irinotecan and oxaliplatin. Folinic acid is not a chemotherapy drug, but is often given with 5FU as it’s been shown to make it work better.

A recent study found that FOLFIRINOX may help to control advanced pancreatic cancer for longer than standard treatment with gemcitabine. However, FOLFIRINOX can cause severe side effects so it is only suitable for people who are well enough to cope with these.

Each cycle of treatment lasts for two weeks. On the first day of each cycle you’re given folinic acid, 5FU, irinotecan and oxaliplatin intravenously. The nurse then attaches a small portable pump to your line or port for you to go home with. The pump will give you continuous chemotherapy with 5FU for the next two days. After this, it’s disconnected from your line and you have a rest from chemotherapy for 11 days. This makes up a cycle of treatment. You may be given up to 12 cycles of treatment over about six months.

Other drugs

Other combinations of drugs, or new drugs, may be used to treat pancreatic cancer. Sometimes, this will be as part of cancer research trials. Treatments called targeted therapies are also being researched in cancer trials. These treatments interfere with the way that cancer cells grow. Research trials are carried out to try to improve the results of treatment for pancreatic cancer.

Back to Chemotherapy explained

How do chemotherapy drugs work?

Chemotherapy drugs work by stopping cancer cells reproducing. The drugs can also affect healthy cells, causing side effects.