Chemotherapy for Pancreatic Cancer

What is chemotherapy?

Chemotherapy is cancer treatment that uses drugs to kill cancer cells by preventing them from growing and dividing. These drugs are systemic treatments, meaning that the drugs travel through the bloodstream and damage cancer cells throughout the body. Unfortunately, chemotherapy can also damage some healthy cells and cause side effects. Chemotherapy may shrink and/or prevent the growth of pancreatic tumors.

What are the different types of chemotherapy?

There are several drugs approved by the United States Food and Drug Administration (FDA) for the treatment of pancreatic cancer.

Gemzar® (gemcitabine) was approved in 1996 for the treatment of unresectable pancreatic cancer. Studies have also shown that there is a benefit to using Gemzar® after surgery. This is called adjuvant therapy. Prior to Gemzar®, 5-FU was used as the standard treatment for unresectable pancreatic cancer. Both of these drugs are still used today.

In September 2013, ABRAXANE® (albumin-bound paclitaxel) was approved to be used in combination with Gemzar® (gemcitabine) as first-line treatment for metastatic pancreatic adenocarcinoma, the most common type of pancreatic cancer.

ONIVYDE® (irinotecan liposome injection), in combination with 5-FU (fluorouracil) and leucovorin, was approved in October 2015 as treatment for metastatic pancreatic adenocarcinoma that has progressed following treatment with gemcitabine based therapy.

In February 2024, the FDA approved the same combination (irinotecan liposome injection) in combination with 5-FU (fluorouracil/leucovorin) plus oxaliplatin as a treatment for patients with metastatic cancer who have not had any other treatment. This combination is called NALIRIFOX.

In addition to the FDA-approved drugs, FOLFIRINOX, a combination of three chemotherapy drugs (5-FU/leucovorin, irinotecan and oxaliplatin) is commonly used in the treatment of metastatic pancreatic adenocarcinoma. In 2010, a Phase III clinical trial showed positive results for patients treated with FOLFIRINOX. Due to the results of this study, FOLFIRINOX is also considered a standard treatment option for patients with metastatic pancreatic cancer. However, patients treated with FOLFIRINOX may experience more severe side effects than those treated with Gemzar® (gemcitabine alone), so this combination is usually given to patients who are healthy enough to tolerate the potential side effects.

Other chemotherapies may be used for pancreatic cancer although they haven’t been specifically approved for this disease, and new chemotherapies and combinations are still under investigation in clinical trials.

Is chemotherapy given with other pancreatic cancer treatments?

Chemotherapy may be given alone or in combination with surgery, targeted therapy, immunotherapy and/or radiation. When chemotherapy is given in combination with radiation, a low dose of chemotherapy is typically used. Chemotherapy may act as a “radiosensitizer” that can enhance the effect of the radiation on the tumor.

The chemotherapy drugs most commonly used in conjunction with radiation therapy are fluorouracil (5-FU) and gemcitabine (Gemzar®). 5-FU is used most often since there is more experience using this drug in combination with radiation and there are fewer side effects.

Why is chemotherapy used to treat pancreatic cancer?

Chemotherapy may shrink and/or prevent the growth of pancreatic tumors, destroy microscopic cancer cells that may have spread prior to surgery, or relieve pain caused by the cancer.

How and where is chemotherapy given?

Chemotherapy drugs can be given through a vein into the bloodstream (intravenously) or by mouth (orally). Usually, patients receive chemotherapy as an outpatient treatment at a hospital, clinic or doctor’s office. The time needed for each treatment session depends on the type of chemotherapy. In some cases, a hospital stay may be necessary if the doctor wants to monitor the patient during the treatment.

What are the side effects?

Because chemotherapy attacks all rapidly dividing cells, including healthy cells, it can cause side effects. Medications are available to treat many of the common side effects. The specific side effects vary depending on the type of chemotherapy, dosage and length of treatment. Normal, healthy cells that divide rapidly, including bone marrow, blood cells, cells of hair follicles and cells in the reproductive and digestive tracts, are more likely to be damaged during chemotherapy treatment. The doctor and patient must often balance possible side effects with potential benefits of treatment. It is important to keep the doctor informed of any side effects or pain. The doctor can only make changes in treatment or treat side effects if he or she is informed by the patient.

The list below shows some of the common side effects that may occur due to chemotherapy drugs used to treat pancreatic cancer. It also indicates some potential ways to manage these side effects. This list is not comprehensive. Side effects are individual and may not occur in each person who receives treatment.

Side Effect Management Suggestions

Changes in Taste (food may taste bland or metallic)

Avoid foods that cause unpleasant tastes. Changes in the dose of the chemotherapy and radiation therapy may help. Eat small, frequent meals. Eating tart foods may help overcome metallic or bitter taste. Cold food might taste better than hot food.

Fatigue

Treat with medications prescribed by a doctor. Drugs may boost red blood cells and help prevent fatigue. A dietitian can provide guidance on a variety of dietary changes. It is important to maintain activity in order to treat fatigue. Taking short walks can boost energy. In addition, taking short rests throughout the day may help.

Diarrhea or Abdominal Cramping

Treat with over-the-counter or prescribed medications as directed by a doctor. A variety of dietary changes can also be made under the guidance of a dietitian.

Hair Loss

Avoid frequent hair washing and use a gentle shampoo. Gently pat hair dry, use a wide-tooth comb instead of a brush and avoid the use of barrettes, rubber bands, hair products and hair dryers. Wear head coverings when outdoors.

Hand/Foot Syndrome

(A condition that causes redness, tenderness, dryness and peeling of the palms and soles. Numbness or tingling may also develop.)

To avoid trauma to hands and feet, wear cotton socks or gloves and avoid tight-fitting shoes. Soak hands in cool water for 10 minutes and then apply a mild moisturizer or petroleum jelly. Cooling the skin with ice packs may also help relieve pain and tenderness. Ask your doctor if an oral supplement of vitamin B6 is appropriate.

Loss of Appetite

Schedule 6-8 small meals and snacks per day. Medications prescribed by a doctor can help stimulate the appetite. Avoid foods that cause unpleasant tastes. Changes in the dose of chemotherapy may help. Eat small, frequent meals. Eating tart foods may help overcome metallic or bitter taste. Cold food might taste better than hot food.

Low White Blood Cell Count

Medications prescribed by a doctor and/or changes in the dose of the chemotherapy can increase white blood cell counts.

Low Red Blood Cell Count

A blood transfusion or medication prescribed by a doctor may be required. Changes in the dose of the chemotherapy can also raise red blood cell counts.

Low Blood Platelet Count

A blood transfusion or medication prescribed by a doctor may be required. Changes in the chemotherapy dose can also raise blood platelet counts.

Nausea and Vomiting

Treat with medications prescribed by a doctor. A dietitian can provide guidance on a variety of dietary changes. Limit the consumption of fried, spicy or rich foods. Drink cool or room temperature liquids between meals to stay hydrated and avoid feeling overly full. Using a motion sickness wristband may help control nausea. Try wearing loose clothing and getting fresh air.

Mouth Sores

Eat soft, moist, bland foods. Avoid spicy and acidic foods. Caffeine and alcohol may irritate the mouth. Drinking through a straw may be helpful. High protein foods will help mouth sores recover more quickly. Rinse mouth with cool water or a mild solution of baking soda and water. Use a soft-bristle toothbrush.

Nail Changes

Avoid biting nails, pushing back cuticles and using fake nails or wraps. Consult a doctor before having a manicure/pedicure. Wear gloves during household chores and moisturize hands and feet frequently. If the nail area becomes inflamed, it may be treated with antibacterial soap or antibacterial/antifungal ointments to prevent infection.

Neuropathy

(A condition that causes tingling or numbness in the hands and feet and, sometimes, in other areas of the body.)

To protect hands and feet, wear cotton socks or gloves and avoid tight-fitting shoes. Also, avoid hot or cold temperatures. Ask your doctor if pain medications, antidepressants, anti-seizure or other treatments are appropriate.

It is important to keep the doctor informed of any side effects or pain. The doctor can only make changes in treatment or treat side effects if informed by the patient.