Chemotherapy for pancreatic cancer

Chemotherapy uses drugs to destroy cancer cells. These drugs target rapidly dividing cells throughout the whole body. This means that chemotherapy kills cancer cells but it can also damage healthy cells.

With most types of chemotherapy, the drugs travel through the blood to reach and destroy cancer cells all over the body, including cells that may have broken away from the primary tumour. This is described as systemic therapy.

Most people with pancreatic cancer have chemotherapy at some point during their treatment. If you have chemotherapy, your healthcare team will use what they know about the cancer and about your health to plan the drugs, doses and schedules.

Chemotherapy may be the only treatment you have, or it may be used along with other cancer treatments. You may have chemotherapy to:

• treat unresectable pancreatic cancer
• shrink a borderline resectable tumour before surgery to try to make it resectable (called neoadjuvant chemotherapy)
• destroy cancer cells left behind after surgery and reduce the risk that the cancer will come back (recur) (called adjuvant chemotherapy)
• kill cancer cells that may have broken off and spread (called micrometastasis) before surgery for resectable cancer (called neoadjuvant therapy)
• relieve pain or control the symptoms of advanced or metastatic pancreatic cancer (called palliative chemotherapy)

Pancreatic cancer is usually treated with a combination of chemotherapy drugs. The most common chemotherapy drug combinations used are:

• FOLFIRINOX – irinotecan, oxaliplatin, fluorouracil (also called 5-fluorouracil or 5-FU) and leucovorin
• gemcitabine and nab-paclitaxel
• gemcitabine and capecitabine
• fluorouracil and leucovorin
• gemcitabine and cisplatin
• oxaliplatin, fluorouracil and leucovorin
• nanoliposomal irinotecan, fluorouracil and leucovorin
• irinotecan, fluorouracil and leucovorin

The most common chemotherapy drugs used on their own for pancreatic cancer include:

• gemcitabine
• capecitabine
• fluorouracil
• irinotecan
• nab-paclitaxel
• oxaliplatin
• cisplatin

All of these chemotherapy drugs and drug combinations are given through a needle into a vein (intravenously) except for capecitabine, which is given as a pill by mouth (orally). How long you have chemotherapy for depends on the drugs and doses given, if you have any other treatments and the cancer's response to treatment.

Nanoliposomal irinotecan may not be available at all treatment centres or covered by all provincial and territorial health plans. Your healthcare team will talk to you about your options if they think you may benefit from this drug.

Chemotherapy and radiation therapy may be given during the same time period to treat pancreatic cancer. This is called chemoradiation. Some chemotherapy drugs can help make radiation work better by making cancer cells more sensitive to radiation. Combining chemotherapy and radiation therapy can be more effective than either treatment on its own.

Chemotherapy drugs used in chemoradiation for pancreatic cancer include:

• gemcitabine
• fluorouracil
• capecitabine

Chemoradiation is often given after you have had chemotherapy for pancreatic cancer. You may also have more chemotherapy treatment after chemoradiation.

Side effects of chemotherapy will depend mainly on the drug, the dose, how it's given, and your overall health. Tell your healthcare team if you have side effects that you think are from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Common side effects of chemotherapy drugs for pancreatic cancer include:

• nausea and vomiting
• fatigue
• hair loss
• sore mouth and throat
• skin problems, such as a rash, dry skin and sensitive skin
• loss of appetite
• weight loss
• diarrhea
• constipation
• low blood cell counts, which can cause infection, bruising more easily than normal, nosebleeds and anemia
• peripheral nerve damage
• hand-foot syndrome

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.

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