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 three chemotherapy drugs approved by the U.S. Food and Drug Administration (FDA) to treat pancreatic cancer.

In 1996, gemcitabine (Gemzar®) was approved as the standard of care treatment for unresectable pancreatic cancer. However, some studies have indicated that there is a benefit to using gemcitabine after surgery for pancreatic cancer. Prior to gemcitabine, fluorouracil (5-FU) was used as the first-line treatment for unresectable pancreatic cancer. Both of these drugs are still used today.

Most recently, in September 2013, albumin-bound paclitaxel (ABRAXANE®) was approved in combination with gemcitabine (Gemzar®) to treat advanced (metastatic) pancreatic cancer.

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 Potential Management Techniques
Fatigue It is important to maintain activity in order to treat fatigue.  Taking short walks can maintain energy and function.  In addition, the doctor may prescribe drugs to boost red blood cells and aid in preventing fatigue.  A variety of dietary changes can also be made under the guidance of a dietitian.
Lowered blood cell counts Changes in the dose of the chemotherapy can increase blood cell counts.  Medications prescribed by a doctor and/or a blood transfusion may be required.
Gastrointestinal discomfort (includes diarrhea, abdominal cramping, nausea and vomiting) 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.
Neuropathy Protect hands and feet by wearing cotton socks or gloves and avoiding tight-fitting shoes.  Ask your physician if pain medications, antidepressants, anti-seizure, or other treatments are appropriate.
Loss of appetite and changes in taste Eat small, frequent meals.  Eating tart foods may help to overcome a metallic or bitter taste.  Cold food might taste better than hot food.  Adjustments to the dose of the chemotherapy and radiation therapy may help reduce changes in taste.  Medications prescribed by a doctor can help stimulate the appetite.
Hand/Foot syndrome Soak hands in cool water and then apply a mild moisturizer or petroleum jelly.  Avoid trauma to hands and feet by wearing cotton socks or gloves and avoiding tight-fitting shoes.  Cooling the skin with ice packs may also help relieve pain and tenderness.  Ask the doctor if an oral supplement of vitamin B6 is appropriate.

 

The information and services provided by the Pancreatic Cancer Action Network, Inc. are for informational purposes only. The information and services are not intended to be substitutes for professional medical advice, diagnosis or treatment. If you are ill, or suspect that you are ill, see a doctor immediately! The Pancreatic Cancer Action Network does not recommend nor endorse any specific physicians, products or treatments even though they may be mentioned on this site. In addition, please note that any personal information you provide to the Pancreatic Cancer Action Network’s associates during telephone and/or email consultations may be stored in a secure database to assist the Pancreatic Cancer Action Network, Inc. in providing you with the best service possible. Portions of the constituent data stored in this database may be used to inform future programs and services of the Pancreatic Cancer Action Network, Inc., and may be provided in aggregate form to third parties to guide future pancreatic cancer research and treatment efforts. The Pancreatic Cancer Action Network, Inc. will not provide personal identifying information (such as your name or contact information) to third parties without your advanced written consent.  080923