Chemotherapy for pancreatic cancer

Chemotherapy is one of the main treatments for pancreatic cancer. It uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.

You might have chemotherapy:

  • before surgery (neo adjuvant chemotherapy)
  • after surgery (adjuvant chemotherapy)
  • with radiotherapy (chemoradiotherapy)
  • to relieve symptoms and control the cancer for as long as possible

 Common chemotherapy drugs for pancreatic cancer are:

  • gemcitabine
  • capecitabine
  • fluorouracil (5FU)
  • irinotecan
  • oxaliplatin
  • nab-paclitaxel (Abraxane)
  • cisplatin

You may have one of these drugs or more than one of them together.

When you have chemotherapy

Before surgery

This is called neo adjuvant chemotherapy. If you have a borderline resectable tumour you have chemotherapy before surgery. This means the cancer is right next to a main blood vessel and the surgeons don’t think they can remove all the cancer. 

Giving chemotherapy first may shrink the cancer enough to make surgery possible.

After surgery

This is known as adjuvant chemotherapy. You might have chemotherapy after surgery to lower the risk of the cancer coming back.

You have adjuvant chemotherapy for up to 6 months. It should start within 3 months of having surgery.

With radiotherapy

This is called chemoradiotherapy. Some people might have this before surgery. This is usually as part of a clinical trial Open a glossary item.

People with locally advanced pancreatic cancer may have chemoradiotherapy after a course of chemotherapy. 

To control the cancer for as long as possible

You usually have chemotherapy if the cancer has spread to another part of your body, such as the liver. This is called metastatic pancreatic cancer. This means surgery isn’t possible to remove the cancer. Depending on how well you are, you might have one chemotherapy drug or a combination of chemotherapy drugs.

Unfortunately, chemotherapy doesn't help everyone with pancreatic cancer. Some people will feel better with treatment and some may live longer. But some people having chemotherapy won't get much benefit at all. You might want to consider the benefits and disadvantages of treatment before deciding whether to have it. Your doctor and specialist nurse will talk to you about this.

If the cancer comes back after treatment or continues to grow with treatment

You might be able to have a different treatment if the first treatment isn’t working or the side effects are too bad. This is called second line treatment. Your doctor will discuss with you what options are available to you in this situation.

Types of chemotherapy

For people who are fit, you are most likely to have a drug combination called FOLFIRINOX. FOLFIRINOX is made up of the chemotherapy drugs:

  • fluorouracil (5FU)
  • irinotecan
  • oxaliplatin

Because of the high risk of serious side effects, there is a different version of this combination that is generally used. It has lower amounts (doses) of some of the drugs. This is called modified FOLFIRINOX. 

Other combinations of chemotherapy for pancreatic cancer include:

  • gemcitabine and nab-paclitaxel
  • gemcitabine and capecitabine (GemCap)
  • oxaliplatin and fluorouracil (FOLFOX)
  • oxaliplatin and capecitabine (OxCap)
  • gemcitabine and cisplatin (GC)

If you are not well enough to have a combination of chemotherapy drugs you might have one on its own, such as:

  • gemcitabine
  • capecitabine

If you are having chemotherapy with radiotherapy you usually have capecitabine.

How you have chemotherapy

You have most chemotherapy drugs for pancreatic cancer as a drip into your bloodstream (intravenously). If you are having capecitabine, you take it as a tablet.

You usually have the treatment in cycles. You have treatment for a few days or weeks and then a time with no treatment to allow your body to recover.

Chemotherapy into your bloodstream

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

  • central line
  • PICC line
  • portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

Taking your chemotherapy tablets

You must take tablets according to the instructions your doctor or pharmacist gives you.

Speak to your pharmacist if you have problems swallowing the tablets.

Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, no more or less.

If you are sick after taking chemotherapy tablets, don’t take them again straight away. Talk to your medical team for advice if you miss a dose of a cancer drug or want to stop taking treatment for any reason.

Where you have chemotherapy

You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. Because of a lack of space, you may not be able to bring a friend or family member with you. But they may be able to drop you off and pick you up. Speak to your team about what is possible.

You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.

Some hospitals may give certain chemotherapy treatments to you in the community. For example, at a GP surgery or at home. Your doctor or nurse can tell you more about what options are available to you locally.

The following short video explains about what chemotherapy is like. This video is about 3 minutes long.

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You usually have these the day before or on the day you start treatment. You have blood tests before each cycle of chemotherapy.

Before starting treatment with capecitabine or fluorouracil (5FU) you have a blood test to check levels of an enzyme called dihydropyrimidine dehydrogenase (DPD). A low DPD level might mean you are more likely to have severe side effects from these drugs. So you may start treatment with a lower amount (dose) of the drug, or have a different treatment. Your doctor or nurse will talk to you about this.

Side effects of chemotherapy

Chemotherapy for pancreatic cancer can cause side effects and these can vary from person to person. It depends on the chemotherapy drugs you are having, the amount you have and if you have them with other cancer drugs. Some of the common chemotherapy side effects include:

  • feeling or being sick
  • loss of appetite
  • weight loss
  • an increased risk of infection
  • tiredness and weakness
  • bruising, bleeding gums or nose bleeds
  • diarrhoea
  • hair loss
  • constipation

When you go home

Chemotherapy for pancreatic cancer can be difficult to cope with. Tell your healthcare team about any problems or side effects that you have. Your nurse will give you telephone numbers to call if you have any problems at home.

Research into chemotherapy for pancreatic cancer

Researchers are looking at ways to improve treatment for pancreatic cancer. So your doctor might ask if you would like to take part in a clinical trial. 

  • BMJ Best Practice Pancreatic Cancer
    H M Kocher and others
    BMJ Publishing Group, last updated November 2022

  • Pancreatic cancer in adults: diagnosis and management
    National Institute for Health and Care Excellence (NICE), February 2018

  • Pancreatic cancer
    J D Mizrahi and others
    The Lancet, June 2020. Volume 395, Pages 2008 to 2020

  • Chemotherapy for pancreatic cancer
    C Springfeld and others
    La Presse Medicale, MArchg 2019.  Volume 48, Issue 3, Part 2, Pages e159 to e174

  • eUpdate – Cancer of the Pancreas Treatment Recommendations: Section: Treatment Adjuvant Chemotherapy
    ESMO Guidelines Committee, March 2019

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact with details of the particular issue you are interested in if you need additional references for this information.

Last reviewed: 
12 Apr 2023
Next review due: 
12 Apr 2026

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