Chemotherapy for pancreatic cancer

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.

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.

Find out about these chemotherapy drugs and their side effects

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.

Find out more about having chemotherapy into your bloodstream

Taking your chemotherapy tablets

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.

Find out more about taking chemotherapy tablets

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.

Find out more about having a DPD deficiency

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

General information about chemotherapy and its side effects

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. 

Find out about research into pancreatic cancer