Chemotherapy for Pancreatic Cancer

Doctors use chemotherapy to help shrink pancreatic cancer or prevent the tumors from growing. It can also destroy microscopic cancer cells before or after surgery or relieve pain.

The treatment often pairs with surgery and radiation:

• Before surgery (neoadjuvant chemotherapy): A process to shrink the tumor so less extensive surgery is needed for removal. It often is used if a tumor is too big to be removed when first diagnosed.
• After surgery (adjuvant chemotherapy): A process that tries to kill any cancer cells left behind after surgery or those that may have spread but can’t be seen. Adjuvant chemotherapy tries to kill remaining cancer cells so they can’t form tumors in other places in the body. This lowers the chance the cancer will come back.
• For advanced pancreatic cancer: If surgery can’t completely remove the cancer, if it spread, or if surgery isn’t an option, chemotherapy can be used.

If paired with radiation, a small dose of chemotherapy may be used to enhance the effect of the radiation on the tumor.

The United States Food and Drug Administration approved four chemotherapy drugs for pancreatic cancer:

• ABRAXANE® (albumin-bound paclitaxel): Pairs with Gemzar as a first treatment for metastatic pancreatic adenocarcinoma, the most common type of pancreatic cancer.
• Gemzar® (gemcitabine): Used in treatment of unresectable pancreatic cancer and after surgery. Pairs with ABRAXANE for treatment for metastatic pancreatic adenocarcinoma, the most common type of pancreatic cancer.
• 5-FU® (fluorouracil): Was the main treatment for unresectable pancreatic cancer before Gemzar, and remains in use today. Pairs with ONIVYDE and leucovorin to treat metastatic pancreatic adenocarcinoma that has progressed after treatment with Gemzar.
• ONIVYDE® (irinotecan liposome injection): Combines with 5-FU and leucovorin to treat metastatic pancreatic adenocarcinoma that has progressed after treatment with Gemzar.

Other treatments also are used:

• FOLFIRINOX: A combination of three chemotherapy drugs used in the treatment of metastatic pancreatic adenocarcinoma, the most common type of pancreatic cancer. Patients who receive FOLFIRINOX may experience more severe side effects than those who use Gemzar.

Clinical trials are underway on other chemotherapy drugs for pancreatic cancer.

Medical oncology includes a range of treatment approaches using drugs or other chemicals. Depending on your type and stage of pancreatic cancer, your medical oncologist may use one or several types of treatment.

Medical oncology options

Medical oncology treatments for pancreatic cancer at UPMC Hillman Cancer Center include:

• Chemotherapy — this is the treatment of cancer with drugs or chemicals. Exocrine pancreatic cancers respond to chemo better than neuroendocrine tumors. Resectable tumors (removable by surgery) respond better to chemo than more advanced pancreatic cancers (such as Stage III, which includes locally advanced and unresectable tumors). For metastatic pancreatic cancer, chemotherapy can help to slow the spread of the disease.
• Immunotherapy or biologic therapy — this type of treatment works with the immune system to alter the chemical environment of the cancer. Colony stimulating factors, interferon, interleukin, and monoclonal antibodies are examples of biologic agents.
• Regional perfusion — this therapy is for cancer still confined to the pancreas but advanced beyond surgical removal. Regional perfusion may extend and improve the quality of your life.

You may also have the chance to take part in a clinical trial of new cancer drugs or protocols.

In some cases, medical oncology can cause side effects like fatigue or hair loss. Your care team will address any side effects if they occur.

Comfort is important during chemotherapy treatments. Items you should bring include:

• Light, comfortable clothes to wear
• A blanket and pillows
• Photos
• Healthy snacks
• Activities such as reading materials or a smartphone
• Water
• Personal care items like a toothbrush, tissues and hand sanitizers

Ask your doctor questions before beginning treatment. Some examples include:

• What kind of chemotherapy will I be receiving?
• Why is this the treatment we’re doing?
• Are there other options?
• How will it be given?
• Where will it take place?
• How long is a treatment session?
• How often will I need chemo?
• When will chemo stop?
• How will we know it’s working?
• What are the side effects?

Common side effects of chemotherapy include:

• Bone marrow depression
• Fatigue
• Nausea and vomiting
• Temporary hair loss

Learn more about managing side effects of chemotherapy.

UPMC Hillman Cancer Center is the only one in western Pennsylvania designated as a Comprehensive Cancer Center by the National Cancer Institute. Our team works together to customize the best treatment plan for your personal needs.

We are on the front line of research and clinical trials of new and innovative ways to battle cancer.

And with more than 60 locations across Pennsylvania, Ohio, and western New York, you can find a place for treatment close to home.