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A quick guide to what's on this page

Chemotherapy for pancreatic cancer

Chemotherapy uses anti cancer (or cytotoxic) drugs to destroy cancer cells. You may have chemotherapy after pancreatic surgery. If the cancer was totally removed, the chemotherapy can lower the risk of cancer coming back in the future. If it wasn't possible to remove all the cancer, chemotherapy may help to shrink what was left behind. 

Doctors are looking into chemotherapy or a combination of chemotherapy and radiotherapy before you have surgery (known as neo adjuvant treatment). The idea is that the treatment shrinks the cancer so that there is a greater chance of completely removing it with surgery. You are most likely to have this as part of a clinical trial.

You may have chemotherapy combined with radiotherapy for locally advanced pancreatic cancer. This may help shrink or slow the cancer down. For a few people, this treatment may shrink the cancer enough to make surgery possible. You may have this as part of a clinical trial as doctors are still looking at the best way of giving this treatment.

If you have symptoms of advanced pancreatic cancer, your doctor may suggest chemotherapy. It might shrink your cancer and help to relieve some of the symptoms. Chemotherapy may help to slow down the cancer growth for a while. Unfortunately chemotherapy doesn’t help everyone with pancreatic cancer.
 

CR PDF Icon You can view and print the quick guides for all the pages in the treating pancreatic cancer section.

 

 

Chemotherapy after surgery

You may have chemotherapy after surgery for pancreatic cancer. If your surgeon completely removed your cancer, you may have chemotherapy to help lower the risk of the cancer coming back in the future (known as adjuvant chemotherapy). If it wasn't possible to remove all the cancer, the chemotherapy may help to shrink what was left behind. 

A trial called ESPAC-1 showed that chemotherapy with the drug fluorouracil (5-FU) after surgery can help to reduce the risk of the cancer coming back, or at least delay it. Another trial, ESPAC-3, compared giving 5-FU with gemcitabine after surgery. They worked equally well. As gemcitabine generally has fewer side effects than 5-FU doctors are increasingly using this drug. 

A trial running at the moment, called ESPAC-4, is comparing gemcitabine on its own with gemcitabine and capecitabine (GemCap), after surgery. Capecitabine is a type of fluorouracil that you take as a tablet. Doctors want to know if the combination of chemotherapy drugs works better than having gemcitabine on its own.

Doctors are also looking into chemotherapy before you have surgery (neo adjuvant chemotherapy). The idea is that the chemotherapy shrinks the cancer so that there is a greater chance of completely removing it with surgery. Results from randomised clinical trials are needed before doctors can see whether this approach improves the outlook for people with cancer of the pancreas.

You can find out about trials for cancer of the pancreas on our clinical trials database. Choose 'pancreatic' from the drop down menu.

 

Combination chemotherapy and radiotherapy

Some doctors are looking into giving this combination treatment before surgery for early pancreatic cancer. They hope this treatment will shrink the cancer so there is a greater chance of removing it all, and may reduce the risk of cancer coming back. You are most likely to have this as part of a clinical trial.

You may have chemotherapy and radiotherapy for locally advanced cancer that cannot be removed with surgery. This may help shrink or slow the growth of cancer. The best way of giving this treatment is still being looked at in trials. But for most people, you will start your treatment with a course of chemotherapy. As long as your cancer does not grow during this time, you will then have radiotherapy and chemotherapy together (chemoradiation). The chemotherapy drug helps the radiotherapy work better. In a few people, this treatment may shrink the cancer enough to make surgery possible. Chemoradiation causes more side effects than having chemotherapy or radiotherapy by themselves, so doctors are looking into ways of reducing these side effects.

 

Chemotherapy for advanced pancreatic cancer

If you have symptoms from advanced pancreatic cancer, your doctor may suggest chemotherapy. The chemotherapy won't cure the cancer but it might shrink your cancer and so help to relieve some of the symptoms. It may help to slow down the growth of the cancer for a while. But chemotherapy doesn't help everyone with pancreatic cancer. Some people will feel better with treatment. And some people may live longer. But unfortunately some people having chemotherapy won't get much benefit at all.

You need to consider whether the trips to hospital and side effects are worth the possible benefit for you. You can always discuss this with your specialist. No one can tell exactly how you will be affected by side effects until you have the treatment. You can start and see how it goes if you like. You can always stop the treatment if you want to.

The National Institute of Health and Clinical Excellence (NICE) have recommended the chemotherapy drug gemcitabine as a first treatment for people with advanced pancreatic cancer. However they do not recommend this for anyone who is so ill they need considerable help with day to day care. They think the side effects of treatment may outweigh the possible benefits in this situation.

If you are well enough, your doctor may offer you gemcitabine combined with capecitabine (GemCap) or a combination of fluorouracil, irinotecan and oxaliplatin (FOLFIRINOX).

Your doctor may ask you to take part in a clinical trial testing chemotherapy. This is because new drugs and new combinations of current drugs are being tested all the time and it is important to find out which treatments work best.

 

The drugs you may have

The drugs used for pancreatic cancer include

Fluorouracil (5-FU)

Fluorouracil is a liquid that you have through a drip into a vein. When you are having fluorouracil, you usually have a vitamin called folinic acid as well, because this helps to make it work better. The links below take you to information about coping with side effects. The most common side effects are

Capecitabine

Capecitabine is a tablet form of fluorouracil. It is also called Xeloda. The side effects of capecitabine are generally the same as for fluorouracil.

Gemcitabine (Gemzar)

Gemcitabine is a liquid that you have through a drip into a vein. The links below take you to information about coping with side effects. The most common side effects are

Usually the side effects with gemcitabine are relatively mild. Gemcitabine is sometimes combined with capecitabine as GemCap. 

There is more about the particular side effects of gemcitabine, capecitabine, fluorouracil, and GemCap in the cancer drugs section.

FOLFIRINOX combination chemotherapy

For advanced pancreatic cancer doctors sometimes use a combination of the chemotherapy drugs fluorouracil, irinotecan and oxaliplatin (FOLFIRINOX). It causes more side effects than having individual chemotherapy drugs. But it can give a better chance of controlling the cancer for a longer time. People need to be quite fit and well to have this combination. 

 

Dietary or herbal supplements and chemotherapy

We don't yet know much scientifically about how some nutritional or herbal supplements may interact with chemotherapy. Some could be harmful. It is very important to let your doctors know if you take any supplements. Or if you are prescribed them by alternative or complementary therapy practitioners.

Talk to your specialist about any other tablets or medicines you take while you are having active treatment. There is information about the safety of herbal, vitamin and diet supplements in the complementary therapies section.

Some studies seem to suggest that fish oil preparations may reduce the effectiveness of chemotherapy drugs. If you are taking or thinking of taking these supplements talk to your doctor to find out whether they could affect your treatment.

 

More information about chemotherapy

For more about chemotherapy generally, look at the main chemotherapy section. It explains the treatment in more detail including 

If you would like more information about chemotherapy, contact our cancer information nurses. They would be happy to help.

There is also a page on pancreatic cancer research in this section.

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Updated: 15 January 2013