Pancreatic cancer chemotherapy

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science

This page was reviewed on June 20, 2022.

The treatment plan for your pancreatic cancer is likely to include chemotherapy, either alone or in combination with radiation therapy, as part of a therapy called as chemoradiation. Chemoradiation is designed to help radiation therapy work better, but it may also cause more severe side effects.

Chemotherapy is delivered either as an injection into the veins (intravenously, or IV) or in pill form (orally). You may have IV infusions in your doctor’s office, hospital or a clinic set up for infusions.

Chemotherapy and radiation therapy may be recommended for patients who aren’t candidates for pancreatic surgery.

Even for those who are candidates for surgery, doctors may recommend chemotherapy in these situations:

  • Before surgery (neoadjuvant), to reduce the size of the tumor and improve the outcome of surgery
  • After surgery (adjuvant), to kill remaining cancer cells and reduce the likelihood of a recurrence

Chemotherapy is given in cycles. One cycle lasts for two to three weeks, followed by a cycle of rest to allow the body to recover.

The cycle schedule depends on which chemotherapy drugs are given. For example, some are given only on the first day of the cycle, while some are given every day for a week, and others are given for a few days in a row, then only once a week. Each cycle starts over and follows a similar pattern.

How many rounds of chemotherapy are recommended will depend on the stage of pancreatic cancer and other factors. Chemotherapy—both adjuvant and neoadjuvant—for pancreatic cancer is given for a total of three to six months. The doctor will determine how long the chemotherapy regimen will last once it’s been determined how the cancer is responding to treatment, which side effects the patient is experiencing and how well he or she is tolerating them.

Chemotherapy drugs for pancreatic cancer

Chemotherapy for pancreatic cancer tends to have better outcomes when patients are given more than one drug, but not everyone can tolerate more than one drug at a time. If you’re healthy enough, you may be given two or more drugs at once. Some patients seem to tolerate neoadjuvant chemotherapy (before surgery) for pancreatic cancer better than adjuvant therapy (after surgery).

According to the American Cancer Society, these are the most commonly used drugs for adjuvant and neoadjuvant chemotherapy for pancreatic cancer:

  • 5-FU (5-fluorouracil)
  • Abraxane® (albumin-bound paclitaxel)
  • Camptosar® (irinotecan)
  • Cisplatin
  • Eloxatin® (oxaliplatin)
  • Gemzar® (gemcitabine)
  • Xeloda® (capecitabine)

These are the most commonly used drugs for those with advanced pancreatic cancer:

  • 5-FU (5-fluorouracil) or Xeloda® (capecitabine)
  • Camptosar® (irinotecan) or Onivyde® (liposomal irinotecan)
  • Gemzar® (gemcitabine)
  • Platinum agents: cisplatin and oxaliplatin
  • Taxanes: Abraxane® (albumin-bound paclitaxel), Taxol® (paclitaxel) and Taxotere® (docetaxel)

Pancreatic cancer chemotherapy side effects

It’s common to experience side effects when undergoing chemotherapy. These drugs not only destroy cancer cells, but they also kill healthy cells like those that line the digestive tract or hair follicles, causing nausea and hair loss, for example.

Some side effects may be mild or go away soon after treatment, while others may be more intense or longer-lasting. Your cancer treatment team will try to prescribe an appropriate dose of chemotherapy to reduce your side effects as much as possible.

Pancreatic cancer patients most likely experience one or more of these side effects:

Sometimes, chemotherapy damages blood-producing cells in the bone marrow, causing:

  • Low white blood cell count, increasing infection risk
  • Low platelet counts, causing increased bleeding or bruising
  • Low red blood cell count, resulting in fatigue or shortness of breath

The chemotherapy drugs cisplatin, oxaliplatin and paclitaxel may cause nerve damage, resulting in peripheral neuropathy, or numbness, tingling or pain in the feet and hands. If you’re taking oxaliplatin, you may experience nerve pain that gets worse when you’re exposed to cold temperatures, including in foods and beverages. This side effect tends to go away after treatment. Cisplatin may cause kidney damage, so doctors increase IV fluids before giving cisplatin to help prevent this. The drug may also cause tinnitus (ringing or other noises in the ears) or hearing loss.

If you experience any side effects with your treatment, be sure to let your doctor know. Some medications are available to reduce the side effects, or your chemotherapy dose may need to be changed.

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