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 for pancreatic cancer

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

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:

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.

Information about specific cancer drugs

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

Questions to ask about chemotherapy

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.

Expert review and references

  • Alberta Health Services. Adenocarcinoma of the Pancreas Clinical Practice Guideline [GI-006]. Alberta Health Services; 2015.
  • American Cancer Society. Pancreatic Cancer. 2016.
  • BCCA protocol summary for palliative combination chemotherapy for advanced pancreatic adenocarcinoma using irinotecan, oxaliplatin, fluorouracil and folinic acid. BC Cancer Agency. Chemotherapy Protocols. Vancouver, BC: BC Cancer Agency; 2013.
  • BCCA protocol summare for first-line palliative chemotherapy for advanced gallbladder cancer and cholangiocarcinoma usign gemcitabine and cisplatin. BC Cancer Agency. Chemotherapy Protocols. Vancouver, BC: BC Cancer Agency; 2012.
  • BCCA protocol summary for palliative chemotherapy for upper gastrointestinal tract cancer (gastric, esophageal, gall bladder, pancreas carcinoma and cholangiocarcinoma) and metastatic anal using infusional fluorouracil and cisplatin. BC Cancer Agency. Chemotherapy Protocols. Vancouver, BC: BC Cancer Agency; 2013.
  • BCCA protocol summary for palliative chemotherapy for pancreatic adenocarcinoma, gallbladder cancer and cholangiocarcinoma using gemcitabine. BC Cancer Agency. Chemotherapy Protocols. Vancouver, BC: BC Cancer Agency; 2012.
  • BCCA protocol summary for adjuvant chemotherapy for pancreatic adenocarcinoma using gemcitabine. BC Cancer Agency. Chemotherapy Protocols. Vancouver, BC: BC Cancer Agency; 2012.
  • BC Cancer Agency. Irinotecan Liposome (interim monograph). BC Cancer Agency; 2017: http://www.bccancer.bc.ca/.
  • Chemotherapy or radiotherapy for resectable pancreatic adenocarcinoma. Cancer Care Ontario. Evidence-Based Series (EBS) and Practice Guidelines (PG). Toronto, ON: Cancer Care Ontario; 2013.
  • The use of Folfirinox as first-line treatment for metastatic pancreatic adenocarcinoma. Cancer Care Ontario. Evidence-Based Series (EBS) and Practice Guidelines (PG). Toronto, ON: Cancer Care Ontario; 2011.
  • The treatment of locally advanced pancreatic cancer. Cancer Care Ontario. Evidence-Based Series (EBS) and Practice Guidelines (PG). Toronto, ON: Cancer Care Ontario; 2011.
  • Dragovich, T. Pancreatic Cancer Treatment and Management. 2016: http://emedicine.medscape.com/article/280605-treatment#showall.
  • Dragovich, T. Pancreatic Cancer Guidelines. 2016: http://emedicine.medscape.com/article/280605-treatment#showall.
  • National Cancer Institute. Pancreatic Cancer Treatment (PDQ®) Health Professional Version. 2016.
  • National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Pancreatic Adenocarcinoma (Version 2.2016).
  • Wicklin Gillespie T . Pancreatic exocrine tumors. Handy, CM & O'Dea D (eds.). Pancreatic and Hepatobiliary Cancers. Oncology Nursing Society; 2013: 2:3-11.
  • Winter JM, Brody JR, Abrams RA, Lewis NL, Yeo CJ . Cancer of the pancreas. DeVita VT Jr, Lawrence TS, Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015: 49: 657-684.