Questions about your treatment?
If you have any questions about your treatment if you have locally advanced or advanced cancer, speak to your doctor or nurse.
You can also speak to our specialist nurses on our Support Line.
Read all the NICE guidelines for pancreatic cancer
- Explaining the NICE guidelines for diagnosing and managing pancreatic cancer
- NICE guideline 1: Diagnosing pancreatic cancer
- NICE guideline 2: Specialist pancreatic multidisciplinary teams
- NICE guideline 3: Working out how far pancreatic cancer has spread (staging)
- NICE guideline 4: Emotional (psychological) support
- NICE guideline 5: Managing pain
- NICE guideline 6: Managing diet and nutrition
- NICE guideline 7: Relieving a blocked bile duct or duodenum
- NICE guideline 8: Managing resectable (operable) and borderline resectable pancreatic cancer
- NICE guideline 9: Managing pancreatic cancer that can’t be removed with surgery (inoperable or unresectable cancer)
The NICE guidelines were published in 2018. Since then, there have been some changes in how chemotherapy is used. We have provided some information here, and suggest you follow the links for more up to date information.
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.
9.1 If you have locally advanced cancer, you should be offered a combination of chemotherapy drugs, if you are well enough to deal with the possible side effects.
A combination of drugs might be FOLFIRINOX or gemcitabine with capecitabine (GemCap).
9.2 If you have locally advanced pancreatic cancer and aren’t well enough for combination chemotherapy, your doctor should consider gemcitabine chemotherapy.
9.3 If you are having chemotherapy with radiotherapy (chemoradiotherapy), you should be offered the chemotherapy drug capecitabine.
Read more about chemotherapy for locally advanced cancer and chemoradiotherapy.
Advanced (metastatic) pancreatic cancer
Advanced pancreatic cancer is cancer that has spread to other parts of the body.
First-line treatment
The first chemotherapy drugs you have are called first-line chemotherapy.
9.4 If you have advanced pancreatic cancer, you should be offered FOLFIRINOX chemotherapy if you are well enough to deal with the possible side effects.
9.5 If you are not well enough for FOLFIRINOX, your doctor should consider gemcitabine together with other chemotherapy drugs. For example, you may be offered gemcitabine with nab-paclitaxel.
Nab-paclitaxel (Abraxane®) with gemcitabine is an option for people with advanced pancreatic cancer who can’t have other combinations of chemotherapy drugs.
9.6 If you are not well enough for a combination of chemotherapy drugs, you should be offered gemcitabine alone.
Read more about chemotherapy for advanced pancreatic cancer.
Second-line treatment
When one chemotherapy treatment stops working or if it hasn’t worked, different chemotherapy drugs may be used to try to control the cancer for longer. This is called second-line chemotherapy.
9.7 If you need second-line chemotherapy and haven’t already had chemotherapy that included oxaliplatin, your doctor should consider chemotherapy that includes oxaliplatin.
Chemotherapies that include oxaliplatin are FOLFIRINOX, FOLFOX and FOLFIRI.
9.8 If you need further chemotherapy after FOLFIRINOX, your doctor should consider chemotherapy that includes gemcitabine.
Preventing a blood clot in a vein
People with pancreatic cancer may be at higher risk of a blood clot in a vein.
Doctors should consider giving people with pancreatic cancer who are having chemotherapy a drug called low-molecular-weight heparin (LMWH) to try to prevent a blood clot forming in a vein.
If you are having LMWH, this should continue for as long as you have chemotherapy.
Speak to our nurses
Published: April 2025
Review date: April 2028