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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. This is called adjuvant chemotherapy. If it wasn't possible to remove all the cancer, chemotherapy may help to shrink what was left behind. The most common chemotherapy drugs doctors use are gemcitabine or fluorouracil.

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 advanced pancreatic cancer, your doctor may suggest chemotherapy. It might shrink your cancer and help to relieve some of the symptoms. It may also help some people to live longer. You may have a combination of chemotherapy drugs called FOLFIRINOX (fluorouracil, irinotecan and oxaliplatin). Or you may have gemcitabine with another drug such as nab-paclitaxel. You may have chemotherapy for advanced pancreatic cancer as part of a clinical trial.
 

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Chemotherapy after surgery

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

You usually have chemotherapy for about 6 months. You generally start treatment about 1 or 2 months after surgery. You are most likely to have gemcitabine or fluorouracil (5-FU) chemotherapy.

Researchers continue to look at ways of improving treatment for pancreatic cancer. So your doctor may ask you to take part in a clinical trial. Chemotherapy drugs being looked at after surgery include capecitabine with gemcitabine.

Doctors are also looking into chemotherapy before you have surgery (called 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.

 

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 (such as fluorouracil) 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 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 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 may want 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.

If you are well enough for chemotherapy, you may have a combination of fluorouracil, irinotecan and oxaliplatin chemotherapy. This is called FOLFIRINOX. Or you may have gemcitabine in combination with another chemotherapy drug, for example nab-paclitaxel (Abraxane). This may be as part of a clinical trial.

You can read about research into pancreatic cancer in this section. Your specialist can talk to you about trials that may be suitable. You can also look for trials on our clinical trials database.

 

The drugs you may have

The chemotherapy drugs doctors use for pancreatic cancer include

Gemcitabine (Gemzar)

Gemcitabine is a liquid that you have through a drip into a vein, over about half an hour. You usually have it once a week for 3 weeks, followed by a week with no treatment. Usually the side effects with gemcitabine are relatively mild. The links below take you to information about coping with side effects. Some of the most common side effects include

You may have gemcitabine with other chemotherapy drugs such as capecitabine or nab-paclitaxel.

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. Some of the most common side effects include

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.

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

FOLFIRINOX combination chemotherapy

For advanced pancreatic cancer, doctors may use a combination of the chemotherapy drugs fluorouracil, irinotecan and oxaliplatin (FOLFIRINOX). You have these drugs every 2 weeks through a drip into a vein. It causes more side effects than having a single chemotherapy drug. 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. 

There is information about the side effects of this combination of chemotherapy on our page about FOLFIRINOX.

Nab-paclitaxel

Nab-paclitaxel (Abraxane) is the chemotherapy drug paclitaxel combined with a protein called albumin. It has recently been licensed as a first treatment for pancreatic cancer that has spread to another part of the body (stage 4 cancer). You have it alongside gemcitabine chemotherapy. Nab-paclitaxel is not widely available on the NHS at the moment for pancreatic cancer as it is yet to be looked at by the National Institute of Health and Care Excellence (NICE). The Scottish Medicines Consortium (SMC) have decided not to recommend its use on the NHS in Scotland. In England, doctors may be able to fund it through the Cancer Drugs Fund.

You have nab-paclitaxel through a drip into a vein. It takes about half an hour. Then you have gemcitabine. Common side effects include

Doctors are continuing to look at nab-paclitaxel in clinical trials, to find the best way of giving it. There is information about some of the research into nab-paclitaxel on our page about pancreatic cancer research.

 

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.

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Updated: 1 June 2014