Treatments for unresectable pancreatic cancer

The following are treatment options for unresectable pancreatic cancer. Unresectable means the cancer cannot be removed with surgery. Unresectable pancreatic cancer can be locally advanced (non-metastatic) or metastatic.

Recurrent pancreatic cancer is cancer that has come back after treatment. It is typically treated like unresectable pancreatic cancer.

Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Chemotherapy uses drugs to destroy cancer cells. You may be offered chemotherapy to slow the growth and manage symptoms of unresectable pancreatic cancer.

The most common chemotherapy drug combinations used for unresectable pancreatic cancer are:

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

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

• gemcitabine
• capecitabine
• fluorouracil

If the cancer does not respond to certain drugs or drug combinations, or if it comes back, your healthcare team may also offer chemotherapy as second-line therapy. In addition to the drugs and drug combinations above, you may also have:

• nanoliposomal irinotecan, fluorouracil and leucovorin
• irinotecan, fluorouracil and leucovorin

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.

Find out more about chemotherapy for pancreatic cancer.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. You may be offered external radiation therapy on its own or with chemotherapy (chemoradiation) for locally advanced unresectable pancreatic cancer that doesn't respond to chemotherapy.

External radiation therapy can also be used to relieve symptoms such as pain caused by pancreatic cancer.

Find out more about radiation therapy for pancreatic cancer.

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer. Some people may be offered targeted therapy as a treatment for unresectable pancreatic cancer. The type of targeted therapy given will depend on the type of gene mutation or molecular change found using genetic testing during diagnosis.

Targeted therapies 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 these drugs.

Targeted therapy drugs that may be offered for unresectable pancreatic cancer include:

• erlotinib (Tarceva)– for cancer with an EGFR mutation
• larotrectinib (Vitrakvi)– for cancer with an NTRK fusion mutation
• entrectinib (Rozlytrek)– for cancer with an NTRK fusion mutation
• dabrafenib (Tafinlar)– for cancer with a BRAF mutation
• trametinib (Mekinist)– for cancer with a BRAF mutation
• sotorasib (Lumakras)– for cancer with a KRAS mutation
• selpercatinib (Retevmo)– for cancer with a RET gene fusion mutation

Olaparib (Lynparza) may also be offered as maintenance therapy for cancer with a BRCA1, BRCA 2 or PALB mutation if you previously had chemotherapy with a drug containing platinum (for example, carboplatin or cisplatin).

Some drugs are not yet available in Canada except for patients in a clinical trial. If you have unresectable, metastatic or recurrent pancreatic cancer that cannot be treated with another drug, your healthcare team may recommend a clinical trial for a new targeted therapy drug.

For example, adagrasib (Krazati) is a type of KRAS inhibitor that you may have as part of a clinical trial if you have the rare KRAS G12C mutation.

Find out more about targeted therapy for pancreatic cancer.

If you have unresectable or metastatic pancreatic cancer, you may be offered surgery to relieve your symptoms (called palliative surgery). Or you may have one of the following procedures endoscopically or percutaneously.

A stent placement is the most common treatment to relieve a blockage caused by an unresectable pancreatic tumour. The small metal or plastic tube (stent) helps to keep the bile duct or duodenum (the first segment of the small intestine) open. You may have a stent placed through an ERCP (endoscopic retrograde cholangiopancreatography), a percutaneous transhepatic cholangiography or during another surgery.

A surgical bypass is used when a stent cannot be used to relieve a blockage. A surgeon creates a new path around the blockage for bile to flow from the liver or gallbladder into the intestine, or for digested food to flow from the stomach into the intestine. A biliary bypass is used for a blockage in the bile duct. A gastric bypass is used for a blockage in the duodenum.

Find out more about surgery for pancreatic cancer.

Talk to your doctor about clinical trials open to people with pancreatic cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer.

Find out more about clinical trials.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don't work anymore, they're not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can't have or don't want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.