Chemotherapy

What is chemotherapy?

Chemotherapy is cancer treatment that uses drugs to kill cancer cells by preventing them from growing and dividing.  These drugs are systemic treatments, meaning that the drugs attack all rapidly dividing cells in the body, including cancer cells and healthy cells.  Chemotherapy often prevents pancreatic tumors from growing and sometimes shrinks them.

What are the different types of chemotherapy?
There are currently three chemotherapy drugs approved by the United States Food and Drug Administration (FDA) for the treatment of pancreatic cancer: albumin-bound paclitaxel (ABRAXANE®), gemcitabine (Gemzar®) and fluorouracil (5-FU).

Gemcitabine (Gemzar®) was approved in 1996 for the treatment of unresectable pancreatic cancer. Studies have also shown that there is a benefit to using gemcitabine after surgery for pancreatic cancer. Prior to gemcitabine, fluorouracil (5-FU) was used as the standard treatment for unresectable pancreatic cancer. Both of these drugs are still used today.

Most recently, in September 2013, albumin-bound paclitaxel (ABRAXANE®) was approved to be used in combination with gemcitabine (Gemzar®) as first-line treatment for metastatic pancreatic adenocarcinoma, the most common type of pancreatic cancer.

In addition to the three FDA-approved drugs, FOLFIRINOX, a combination of three chemotherapy drugs (5-FU/leucovorin, irinotecan, and oxaliplatin) is commonly used in the treatment of metastatic pancreatic adenocarcinoma. In 2010, a Phase III clinical trial showed positive results for patients treated with FOLFIRINOX. Due to the results of this study, FOLFIRINOX is also considered a standard treatment option for patients with metastatic pancreatic cancer. However, patients treated with FOLFIRINOX may experience more severe side effects than those treated with gemcitabine alone, so this combination is usually given to patients who are healthy enough to tolerate the potential side effects.

Other chemotherapies for pancreatic cancer are still under investigation in clinical trials.

Is chemotherapy given with other treatments?
Chemotherapy may be given alone or in combination with surgery, targeted therapy, immunotherapy, and/or radiation.  Chemotherapy that is given in conjunction with radiation is usually a lower dose than what is generally administered when chemotherapy is given alone.  Chemotherapy may act as a radiosensitizer.  This means the chemotherapy may enhance the effect of the radiation on the tumor.

The chemotherapy drugs most commonly used in conjunction with radiation therapy are fluorouracil (5-FU) and gemcitabine (Gemzar®).  5-FU is more often administered with radiation therapy since there is more experience using this drug in combination with radiation and there are fewer side effects.

Why is chemotherapy used?
Doctors may use chemotherapy to try to shrink the tumor, to destroy microscopic cancer cells that may have spread prior to surgery, or to relieve pain caused by the cancer.

How and where is chemotherapy given?
Chemotherapy drugs can be administered orally (by mouth) or through a vein into the bloodstream (intravenously).  Usually, patients receive chemotherapy as an outpatient treatment at a hospital, clinic, or doctor’s office.  The time needed for each treatment session depends on the type of chemotherapy.  In some cases, a hospital stay may be necessary if the doctor wants to monitor the patient during the treatment.

What are the side effects?
Because chemotherapy attacks all rapidly dividing cells, including healthy cells, it can cause side effects.  Medications are available to treat many of the common side effects.  The specific side effects vary depending on the type of chemotherapy, dosage, and length of treatment.  Normal, healthy cells that divide rapidly, including bone marrow, blood cells, cells of hair follicles, and cells in the reproductive and digestive tracts, are more likely to be damaged during chemotherapy treatment.  The doctor and patient must often balance possible side effects with potential benefits of treatment.  It is important to keep the doctor informed of any side effects or pain.  The doctor can only make changes in treatment or treat side effects if he or she is informed by the patient.

The following table shows some of the common side effects that may occur due to chemotherapy drugs used to treat pancreatic cancer.  It also indicates some potential ways to manage these side effects.  This list is not comprehensive.  Side effects are individual and may not occur in each person who receives treatment.

Side Effect Management Suggestions
Fatigue Treat with medications prescribed by a doctor.  Drugs may boost red blood cells and help prevent fatigue.  A dietitian can provide guidance on a variety of dietary changes.  It is important to maintain activity in order to treat fatigue.  Taking short walks can boost energy.  In addition, taking short rests throughout the day may help.
Gastrointestinal discomfort
(diarrhea, nausea, vomiting, abdominal cramping)
Treat with over-the-counter or prescribed medications as directed by a doctor.  Limit the consumption of fried, spicy or rich foods.  Drink cool or room-temperature liquids between meals to remain hydrated and avoid feeling overly full.  Using a motion sickness wrist band may help control nausea.  Also, try wearing loose clothing and getting fresh air.
Hand/Foot syndrome
(A condition that causes redness, tenderness, dryness and peeling of the palms and soles. Numbness or tingling may also develop.)
To avoid trauma to hands and feet, wear cotton socks or gloves and avoid tight-fitting shoes.  Soak hands in cool water for 10 minutes and then apply a mild moisturizer or petroleum jelly.  Cooling the skin with ice packs may also help relieve pain and tenderness.  Ask your doctor if an oral supplement of vitamin B6 is appropriate.
Loss of appetite Schedule 6-8 small meals and snacks per day.  Medications prescribed by a doctor can help stimulate the appetite. Avoid foods that cause unpleasant tastes.  Changes in the dose of the chemotherapy therapy may help.  Eat small, frequent meals.  Eating tart foods may help overcome metallic or bitter taste.  Cold food might taste better than hot food.
Lowered blood cell counts A blood transfusion or medications prescribed by a doctor may be required.  Changes in the dose of the chemotherapy can also increase blood cell counts.

Neuropathy
(A condition that causes tingling or numbness in the hands and feet and, sometimes, in other areas of the body.)

To protect hands and feet, wear cotton socks or gloves and avoid tight-fitting shoes.  Also, avoid hot or cold temperatures.  Ask your doctor if pain medications, antidepressants, anti-seizure or other treatments are appropriate.

 

Information provided by the Pancreatic Cancer Action Network, Inc. (“PanCAN”) is not a substitute for medical advice, diagnosis, treatment or other health care services. PanCAN may provide information to you about physicians, products, services, clinical trials or treatments related to pancreatic cancer, but PanCAN does not recommend nor endorse any particular health care resource. In addition, please note that any personal information you provide to PanCAN’s associates during telephone and/or email communications may be stored and used to help PanCAN achieve its mission of assisting patients with, and finding cures and treatments for, pancreatic cancer. Stored constituent information may be used to inform PanCAN programs and activities. Information also may be provided in aggregate or limited formats to third parties to guide future pancreatic cancer research and treatment efforts. PanCAN will not provide personal directly identifying information (such as your name or contact information) to such third parties without your prior written consent unless required or permitted by law to do so.