Chemotherapy uses cytotoxic drugs to destroy cancer. "Cytotoxic" means toxic for the cells. These drugs do not only alter the way in which cancer cells grow and divide, but they may also affect normal cells.
Chemotherapy for pancreatic cancer can be given:
- After surgery to lower the chances of the cancer returning (adjuvant chemotherapy).
- If the cancer cannot be removed surgically, to try to reduce its size and control it for a time.
- To relieve the symptoms caused by cancer.
Sometimes, chemotherapy is given alongside radiotherapy.
Some chemotherapy drugs are given in tablet form, though most are administered by an injection into a vein (intravenous), using one of the following:
- A fine, thin tube inserted into one of the veins in your hand or arm.
- A PICC line: a thin plastic tube placed in a vein on the interior part of your arm.
- A central line: a plastic tube placed in a vein in your chest.
Sometimes, chemotherapy can be given continuously through a small portable pump connected to your line or PICC line. A controlled amount of medication is delivered to the blood stream over a period of time. This means you can take the pump home and spend less time in the hospital.
Chemotherapy is usually given over several treatment sessions.
Each treatment is followed by a period of rest lasting a few weeks, thus allowing the body to recover from the side effects. Together, the treatment and rest period make up one treatment cycle. The number of cycles you will have will depend on the drugs being used and how well the treatment is working.
Most people can have their chemotherapy on an outpatient basis.
Chemotherapy after surgery
If chemotherapy is given after surgery to eliminate cancer, the treatment normally lasts for about six months.
The most commonly used chemotherapy drug is gemcitabine. It is given as a drip into a vein over 30 minutes. Gemcitabine is usually given once a week over three weeks followed by a one-week rest. These four weeks make up one cycle.
Another drug that can be used after surgery is fluorouracil (5FU). It is administered intravenously or as a tablet (capecitabine).
Chemotherapy for advanced pancreatic cancer
Gemcitabine and abraxane are the most commonly used treatments. Sometimes, a combination of chemotherapy drugs called FOLFIRINOX is given. This combination is made up of folinic acid and the chemotherapy drugs fluorouracil (5FU), irinotecan, and oxaliplatin. This combination can help control cancer for longer than standard treatment with gemcitabine; however, it can cause much more severe side effects and is only suitable for people who can cope with these.
How is FOLFIRINOX administered?
Each treatment cycle lasts two weeks. Folinic acid, 5FU, irinotecan, and oxaliplatin are given intravenously on the first day of the cycle. A small pump is connected to your PICC line or central line, and you can take this home. This way, 5FU chemotherapy will be given to you continuously for two days. Afterward, it is disconnected and the rest of the chemotherapy is given over 11 days. This makes up one cycle of your treatment.