Chemotherapy for pancreatic cancer
One of the most common treatments for pancreatic
cancer is chemotherapy (using drugs to destroy cancer cells). For
pancreatic cancer chemotherapy is used in several different
- before or after surgery to remove the cancer
- when the cancer is localised but
- when the cancer has spread beyond the pancreas to
other parts of the body
- on its own or in combination with radiotherapy.
Chemotherapy can be used in several different
- it can be given as a single agent or as a regimen
containing two or three different chemotherapy
- in combination with radiotherapy
- in combination with targeted agents.
What is chemotherapy and how does it
Cytotoxic chemotherapy is the use of anti-cancer
drugs to destroy cancer cells. Compared to normal healthy cells,
cancer cells divide much more frequently and in an uncontrolled
way, forming tumours. As the chemotherapy drugs circulate in the
blood they damage and kill the dividing cancer
Because chemotherapy is a systemic treatment, which
means it works on the whole body, normal cells are also affected.
This happens particularly in areas of the body where cells are
constantly being replaced - such as hair, skin, bone marrow and the
lining of the digestive system. This is why chemotherapy may cause
side effects such as nausea, diarrhoea,
hair loss, fatigue (extreme tiredness) and can make people more
likely to pick up infections.
Most side effects can be well controlled and they
usually disappear when chemotherapy treatment
Different chemotherapy drugs are available and they
can be used in a variety of ways depending on:
- the type of cancer being treated
- where it is in the body
- how advanced it is
- the general health and fitness of the person being
The information in this section applies to all exocrine cancers, which
make up 95% of all pancreatic cancers. The most common type of
exocrine tumour is called pancreatic ductal
People with rarer endocrine cancers (also
known as neuroendocrine tumours NETs or pancreatic (P)NETs) may
have different chemotherapy and drug treatment options open to them
- you can find out more from the NET Patient
How is chemotherapy given?
Chemotherapy can be given intravenously
(as an infusion injected through a vein), orally (tablets) or a
combination of both. It is normally given in 'cycles' - two, three
or four weekly are the most common. There may be more than one dose
of chemotherapy in each cycle. Intravenous chemotherapy is most
often given as an outpatient in the hospital's chemotherapy unit.
Sometimes it may be given as an inpatient, in the community or at
Your oncologist (cancer specialist) will work out
the best chemotherapy drug(s), exact dosage and number of cycles
for you. As everyone responds differently to chemotherapy patients
are closely monitored
throughout their treatment.
Chemotherapy after surgery to remove
If you have had surgery to
completely remove your cancer your oncologist will
discuss with you the potential benefit of having chemotherapy
afterwards. This form of chemotherapy is called adjuvant
chemotherapy and the aim is to try to reduce the chances of the
cancer coming back.
Following national guidelines the drugs most often
used in this situation are gemcitabine or 5-fluorouracil (5-FU). Capecitabine is
an oral chemotherapy drug that may be used instead of 5-FU.
Clinical trials are trying to improve upon the outcome achieved
using either gemcitabine or 5-FU after surgery. For example, the
current trial called ESPAC-4 is comparing standard gemcitabine
chemotherapy after surgery with a combination of gemcitabine and
capecitabine (GemCap). Read more about ESPAC-4 and other clinical trials
for pancreatic cancer.
When will chemotherapy be given?
You will need to be well recovered from your
operation before starting chemotherapy treatment.
- Any post-operative
complications such as chest infections or bleeding need to have
- Your wound should be healed, with no signs of
- You should be able to eat and drink well and your
bowels should be functioning normally
- You need to be back to a reasonable level of normal
activity and fitness.
The best time to start chemotherapy is within 2-3
months of surgery.
Chemotherapy for inoperable
If you have locally advanced or advanced cancer (cancer
that involves the structures around the pancreas or has spread to
other parts of the body) surgery to remove the cancer will not be
possible. However, chemotherapy can be used to relieve your
symptoms and to try to shrink or slow down the growth of the
cancer. Chemotherapy cannot cure the cancer but may help lengthen
life and improve your quality of life.
The initial chemotherapy drug(s) received by a
patient is called first-line therapy. The chemotherapy drug most
often used in these circumstances is gemcitabine as clinical trials have shown
that it is effective in controlling pancreatic cancer and improving
symptoms. Gemcitabine may be given on its own or in combination
with other chemotherapy drugs. In general, patients who are of good
fitness may be considered for combination chemotherapy, whereas
patients who are not very well may be considered for single agent
chemotherapy with gemcitabine alone.
Other drugs and drug combinations are constantly
being tested in clinical trials to see whether they give better
results than gemcitabine. The results of some of these trials that
have been completed are listed below.
- Researchers found that the GemCap
combination treatment (gemcitabine given with capecitabine)
showed increased response rate and survival time over gemcitabine
alone in advanced and metastatic disease when three trials were
considered together. They recommended it should be considered as a
first-line treatment option for advanced and metastatic
- A recent study found that a combination
chemotherapy called FOLFIRINOX (leucovorin, 5-fluorouracil,
irinotecan and oxaliplatin) increased survival time by an
additional four months for people with advanced disease compared to
gemcitabine treatment. The treatment did give rise to significantly
greater side effects. It might be an option for people with
advanced disease who are well enough and fit enough to cope with
this intensive combination treatment.
- A recent study found that nab-paclitaxel
(Abraxane®) combined with gemcitabine showed increased response
rate and survival time over gemcitabine alone in metastatic
disease. Nab-paclitaxel aims to reduce the level of the enzyme that
breaks down gemcitabine in tumour cells and so increase the
gemcitabine level. This treatment is licensed for use in
pancreaticcancer in the UK. It has been reviewed by the Cancer
Drugs Fund (England only) and has been put on their list of
priority treatments that can be funded whilst awaiting review by
NICE to decide whether it will be approved for routine use by the
NHS in England and Wales (Northern Ireland normally follows NICE
advice). It is also scheduled to be to be reviewed by the Scottish
Medicines Consortium (SMC) to decide if it will be approved for
routine use by the NHS in Scotland. For information on how this
treatment can be accessed through the Cancer Drugs Fund in England
or how you might be able to access it in Northern Ireland, Scotland
and Wales read our Abraxane FAQ. but it has not yet been
appraised by NICE to decide whether it will be approved for routine
use by the NHS. Read more about this
drug on the Macmillan
Cancer Support website.
So it is a good idea to talk to your specialist
about other chemotherapy treatment options that may be available.
You may also be eligible to take part in a clinical trial testing
other chemotherapy drugs or chemotherapy combined with other
treatments. You can ask your doctors if any suitable trials are
taking place or read more about ongoing trials on our
When a chemotherapy treatment stops working,
different drugs may be used to try to control the disease for a bit
longer. This is known as second-line therapy. Currently in the UK
there is no standard second-line therapy for pancreatic cancer.
However a recent clinical trial indicated that patients who have
previously received gemcitabine may respond to a combination of oxaliplatin and 5-FU in
the second line setting. This regimen is called FOLFOX and has been
commonly used in advanced colorectal cancer. There are fewer
clinical trials of second-line chemotherapy, and early (phase 1)
clinical trials and other clinical trials investigating novel
agents may be considered if available. Read more about ongoing clinical
trials investigating various potential
Other uses of chemotherapy
Occasionally chemotherapy is given before surgery,
which is known as neo-adjuvant treatment. It is an emerging way of
using chemotherapy to treat pancreatic cancer. The aim is to shrink
the cancer to improve the chance of successful surgery, so it may
be appropriate for someone who is a borderline candidate for
surgery. The evidence for the success of this approach is still
unclear, and it isn't widely used in the UK, but may be offered as
an option within a clinical trial.
Chemotherapy can also be used in
combination with radiotherapy. The chemotherapy drug is
given in the normal way, together with a daily dose of
radiotherapy. This is known as chemo-radiation. The aim is for the
chemotherapy drugs (and sometimes other drugs) to make the cancer
cells more susceptible to radiotherapy.
One phase II trial (known as SCALOP) conducted in the UK
looked at chemo-radiation for locally advanced pancreatic
cancer.After four months of chemotherapy,
chemo-radiation was given to patients whose disease had remained
stable or was responding to treatment. The study showed that
chemo-radiation given in this way is very well tolerated and the
trial outcomes were encouraging in terms of survival in this
For more information read our information on radiotherapy.
effects of chemotherapy
Chemotherapy drugs do cause side effects, though
everyone is affected in different ways. As a general rule, most
people who have chemotherapy will get some side effects, but it is
unusual for every person to get all the documented side effects.
Side effects can also be altered when different chemotherapy drugs
You should let your oncology team know as soon as
you start to experience any side effects as they can give you help
and support to manage these. Most of the time side effects are
manageable and medication may be given to counteract them. For
example, you may be prescribed anti-sickness medication to combat
Perhaps the most significant side effect is the
impact on your blood count. This can result in anaemia; low
platelets, leading to bleeding; or low white cell count
(neutropenia) which makes your body more vulnerable to infections.
You will have your blood count checked regularly while
you are having chemotherapy. Occasionally someone may have a rare
or undocumented side effect from their chemotherapy drug. If this
happens, the medical team will do their best to treat
Further information on chemotherapy and pancreatic cancer
in this section:
- Will I have chemotherapy after my
- Which chemotherapy drug(s) will work best for
- What can I expect the chemotherapy to
- What are the side effects of
- Will chemotherapy help control my
- Will chemotherapy improve my quality of
- Will chemotherapy extend my
- Will chemotherapy relieve any of my
- Which hospital will I have this chemotherapy
- Can I receive chemotherapy closer to where I
- Are there any clinical trials involving
chemotherapy I could take part in?
- Can I go on holiday while having chemotherapy
Published October 2012
Review date September 2014