Chemotherapy in the Treatment of Pancreatic Cancer

Chemotherapy is the use of medications to kill cancer cells.  Some chemotherapeutic agents are taken as oral medications, while most are given as an intravenous infusion.  The drugs enter the bloodstream and are systemically delivered to most of the organs and tissues in the body.  Chemotherapy generally attacks rapidly dividing cells, which found in cancer.  However, the drugs will also destroy some normal cells in the body that are also rapidly dividing, which accounts for many of the unpleasant side effects of thes medications.  Normal rapidly dividing cells in the body include hair follicles and the lining of the gastrointestinal tract which accounts for the hair loss and gastrointestinal distress often encountered when being treated with chemotherapy drugs.

There are multiple chemotherapy regimens that have proven efficacy in treating patients with pancreatic cancer.  Most of the regimens are based on a drug called gemcitabine (trade name Gemzar). Most centers add additional drugs to the gemcitabine based therapy to increase the response to therapy.  A second common regimen is called FOLFIRINOX, which is often reserved for younger patients because of the considerable toxicity associated with the treatment.  Increasingly, new agents are being tested and are becoming available for patients with pancreatic cancer. One recently approved drug is erlotinib (trade name Tarceva) has been added to the regimen of appropriate patients.

Ongoing clinical trials are available to test new regimens and new drugs.  Enrolling in a clinical trial may or may not help an individual patient, but it will certainly help physicians make treatment for pancreatic cancer safer and more effective for patients in the future.

Chemotherapy given after an operation is called adjuvant.  Chemotherapy delivered prior to an anticipated operation to remove the tumor is termed neoadjuvant.  And chemotherapy given to patients with metastatic disease is called palliative.