Chemotherapy for pancreatic cancer

Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. It is usually used to treat pancreatic cancer. Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of chemotherapy. You may also receive other treatments.

Chemotherapy is sometimes combined with radiation therapy to treat pancreatic cancer. This is called chemoradiation. The 2 treatments are given during the same time period.

Chemotherapy is given for different reasons. You may have chemotherapy or chemoradiation to:

• destroy cancer cells in the body
• shrink a tumour before other treatments such as surgery (called neoadjuvant chemotherapy)
• destroy cancer cells left behind after surgery and reduce the risk that the cancer will come back (recur) (called adjuvant chemotherapy)
• relieve pain or control the symptoms of advanced pancreatic cancer (called palliative chemotherapy)
• treat pancreatic cancer that is unresectable (locally advanced or metastatic)

Chemotherapy is usually a systemic therapy. This means that the drugs travel through the bloodstream to reach and destroy cancer cells all over the body, including those that may have broken away from the primary tumour in the pancreas.

Chemotherapy drugs used to treat pancreatic cancer include:

• gemcitabine (Gemzar)
• 5-fluorouracil (Adrucil, 5-FU)
• folinic acid (leucovorin)
• irinotecan (Camptosar)
• oxaliplatin (Eloxatin)  
• nab-paclitaxel (Abraxane)
• capecitabine (Xeloda)

The most common chemotherapy drug combinations used to treat pancreatic cancer include:

• 5-fluorouracil and folinic acid
• FOLFIRINOX – folinic acid, 5-fluorouracil, irinotecan and oxaliplatin
• gemcitabine and nab-paclitaxel
• gemcitabine and capecitabine

If pancreatic cancer does not respond to drugs used in earlier treatments or if it comes back, the following drugs may be used:

• 5-fluorouracil and folinic acid, or capecitabine, with or without oxaliplatin
• nanoliposomal irinotecan (Onivyde) with 5-fluorouracil and leucovorin (folinic acid)

The most common chemotherapy drugs used in chemoradiation include:

• 5-fluorouracil
• capecitabine

Side effects can happen with any type of treatment for pancreatic cancer, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.

Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. If you develop side effects, they can happen any time during, immediately after or a few days or weeks after chemotherapy. Sometimes late side effects develop months or years after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of chemotherapy will depend mainly on the type of drug, the dose, how it’s given and your overall health. Some common side effects of chemotherapy drugs used for pancreatic cancer are:

• low blood cell counts( bone marrow suppression)
• low white blood cell count
• low platelet count
• anemia
• nausea and vomiting
• loss of appetite
• taste changes
• sore mouth and throat
• diarrhea
• constipation
• flu-like symptoms, such as fever, chills, muscle and joint aches or pain
• fatigue
• skin problems
• hand-foot syndrome
• peripheral nerve damage
• hair loss

Tell your healthcare team if you have these side effects or others you think might be from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.

Find out more about chemotherapy and side effects of chemotherapy. To make the decisions that are right for you, ask your healthcare team questions about chemotherapy.