How is chemotherapy used for pancreatic cancer?

Chemotherapy after surgery to remove the cancer

You should be offered chemotherapy after surgery to remove the cancer (such as the Whipple’s procedure), to try to reduce the chances of the cancer coming back. There are three types of chemotherapy that may be used:

• FOLFIRINOX
• gemcitabine with capecitabine (GemCap)
• gemcitabine.

The type of chemotherapy you are offered will depend on how you are feeling and what your doctor thinks will be best for you.

You should be given time to recover properly from your surgery before starting chemotherapy, as you need to be well enough for six months of chemotherapy. Chemotherapy may start up to 12 weeks after your surgery.

Pancreatic cancer and surgery to remove it can cause problems with digestion, including weight loss, losing your appetite, and changes to your poo. If you have any problems after surgery, speak to your doctor, nurse or dietitian to make sure these don’t delay the chemotherapy. A dietitian is an expert in diet and nutrition.

Chemotherapy for borderline resectable pancreatic cancer

Borderline resectable cancer is cancer that has grown very close to major blood vessels near the pancreas. Surgery to remove the cancer may be possible, but it depends which blood vessels are affected, and how far the cancer has grown.

You may be offered chemotherapy. Some people may then be offered chemotherapy together with radiotherapy (see below). The aim is to shrink the cancer away from major blood vessels so that there’s a better chance of removing it.

You will have scans before, during and at the end of your treatment to see how the chemotherapy is working.

Chemotherapy with radiotherapy (chemoradiotherapy)

Chemotherapy used together with radiotherapy is called chemoradiotherapy. Radiotherapy uses high energy x-rays (radiation) to damage cancer cells and stop the cancer growing. The chemotherapy may make the cancer cells more sensitive to radiotherapy, so that it works better.

Some people with borderline resectable cancer (see above) and locally advanced cancer may be offered chemoradiotherapy.

If you have chemoradiotherapy, you will normally have chemotherapy on its own for around three to six months to begin with. You will then have a CT scan. If this shows that the cancer hasn’t grown or spread, you will start chemoradiotherapy.

The chemotherapy drug most often used with radiotherapy is capecitabine, which is a tablet. You will have radiotherapy and capecitabine five days a week, for five to six weeks.

Chemotherapy for cancer that can’t be removed

If it’s not possible to remove the cancer with surgery (inoperable cancer), you may be offered chemotherapy to help control the cancer.

Locally advanced pancreatic cancer

Locally advanced pancreatic cancer is cancer that has spread to the large blood vessels near the pancreas, or to a number of lymph nodes. It’s not usually possible to remove the cancer with surgery.

You should be offered chemotherapy, and sometimes chemoradiotherapy. This may shrink the cancer and slow down its growth. It can also help with any symptoms and help you feel better. For a small number of people, this treatment may shrink the cancer enough to make surgery possible.

You may be offered FOLFIRINOX or gemcitabine with capecitabine (GemCap). If you are not well enough to deal with the possible side effects of these treatments, your oncologist should consider gemcitabine on its own.

You will have scans before, during and at the end of your treatment to see how the chemotherapy is working.

Advanced pancreatic cancer

Advanced (metastatic) pancreatic cancer is cancer that has spread from the pancreas to other parts of the body. Surgery to remove the cancer won’t be possible.

Chemotherapy may help to control the cancer and help with symptoms. It won’t cure the cancer but it may help you live longer and generally feel better.

You will need to be well enough for chemotherapy. You will have a scan every three months to see how well the chemotherapy is working and how it’s affecting you.

• You may be offered FOLFIRINOX if your doctor thinks you are well enough to deal with the possible side effects.
• Or you may be offered gemcitabine together with nab-paclitaxel.
• (If you aren’t able to have these treatments, your doctor may consider gemcitabine with capecitabine (GemCap).
• If you aren’t well enough for a combination of chemotherapy drugs, you may be offered gemcitabine on its own.

Speak to your chemotherapy team about which treatment may be best for you.

You might be able to have chemotherapy as part of a clinical trial. Ask your oncologist if there are any trials that might be suitable for you.

Second-line chemotherapy

The first chemotherapy treatment you have is called first-line chemotherapy. If you need more chemotherapy, you will have different drugs. This is called second-line chemotherapy. The aim is to control the cancer and any symptoms.

There are different second-line options which may be used.

• If you have had FOLFIRINOX, you may be able to have gemcitabine (with or without capecitabine).
• If you have had gemcitabine (with or without nab-paclitaxel), and are well enough to have further treatment, you may be able to have FOLFIRINOX, FOLFOX or FOLFIRI.
• If you have had gemcitabine and are not well enough to deal with more side effects, you may be able to have capecitabine.

Clinical trials looking at chemotherapy

Clinical trials are research studies involving people. They help doctors find new treatments or better ways of providing treatment. Some clinical trials are looking at chemotherapy and pancreatic cancer.

Updated April 2022

Review date April 2024