Chemotherapy for pancreatic cancer
Chemotherapy is one of the main treatments for pancreatic cancer. It uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.
You might have chemotherapy:
- before surgery (neo adjuvant chemotherapy)
- after surgery (adjuvant chemotherapy)
- with radiotherapy (chemoradiotherapy)
- to relieve symptoms and control the cancer for as long as possible
Common chemotherapy drugs for pancreatic cancer are:
- gemcitabine
- capecitabine
- fluorouracil (5FU)
- irinotecan
- oxaliplatin
- nab-paclitaxel (Abraxane)
- cisplatin
You may have one of these drugs or more than one of them together.
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 
.
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.
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.
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.
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.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied, such as books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.
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.
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
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.
