Treatment Options for Pancreatic Cancer - Overview

Five types of standard treatment are used:

• Surgery
• Radiation therapy
• Chemotherapy
• Chemoradiation therapy
• Targeted therapy
• There are treatments for pain caused by pancreatic cancer.
• Patients with pancreatic cancer have special nutritional needs.
• New types of treatment are being tested in clinical trials.
• Treatment for pancreatic cancer may cause side effects.

Surgery

One of the following types of surgery may be used to take out the tumor:

Whipple procedure: A surgical procedure in which the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct are removed.

Total pancreatectomy: This operation removes the whole pancreas, part of the stomach, part of the small intestine, the common bile duct, the gallbladder, the spleen, and nearby lymph nodes.

Distal pancreatectomy: Surgery to remove the body and the tail of the pancreas. The spleen may also be removed if cancer has spread to the spleen.

If the cancer has spread and cannot be removed, the following types of palliative surgery may be done to relieve symptoms and improve quality of life:

Biliary bypass: If cancer is blocking the bile duct and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the doctor will cut the gallbladder or bile duct in the area before the blockage and sew it to the small intestine to create a new pathway around the blocked area.

Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin tube) to drain bile that has built up in the area.

Gastric bypass: If the tumor is blocking the flow of food from the stomach, the stomach may be sewn directly to the small intestine so the patient can continue to eat normally.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug.

Common drugs used to treat pancreatic cancer include:

• Abraxane (Paclitaxel Albumin-stabilized Nanoparticle Formulation)
• 5-FU (Fluorouracil Injection)
• Gemcitabine Hydrochloride
• Irinotecan Hydrochloride Liposome
• Onivyde (Irinotecan Hydrochloride Liposome)
• Capecitabine (Xeloda)

Common Drug Combinations Used in Pancreatic Cancer:

• FOLFIRINOX
• GEMCITABINE-ABRAXANE
• GEMCITABINE-OXALIPLATIN
• FOLFOX

Targeted therapy

• Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells.
• Targeted therapies may cause less harm to normal cells than chemotherapy or radiation therapy do.
• Tyrosine kinase inhibitors (TKIs) are targeted therapy drugs that block signals needed for tumors to grow. Erlotinib is a type of TKI used to treat pancreatic cancer.
• PARP inhibitors are also targeted therapies. Olaparib is an example.

Palliative Therapy

• There are treatments for pain caused by pancreatic cancer.
• Pain can occur when the tumor presses on nerves or other organs near the pancreas. When pain medicine is not enough, there are treatments that act on nerves in the abdomen to relieve the pain.
• The doctor may inject medicine into the area around affected nerves or may cut the nerves to block the feeling of pain.
• Radiation therapy with or without chemotherapy can also help relieve pain by shrinking the tumor.

Treatment of Resectable or Borderline Resectable Pancreatic Cancer

Treatment of resectable or borderline resectable pancreatic cancer may include the following:

• Chemotherapy with or without radiation therapy followed by surgery.
• Surgery.
• Surgery followed by chemotherapy.
• Surgery followed by chemoradiation.
• Clinical trials
• Surgery to remove the tumor may include Whipple procedure, total pancreatectomy, or distal pancreatectomy.

Palliative therapy can be started at any stage of disease.

Treatment of Locally Advanced Pancreatic Cancer

Treatment of pancreatic cancer that is locally advanced may include the following:

• Chemotherapy with or without targeted therapy.
• Chemotherapy and chemoradiation.
• Surgery (Whipple procedure, total pancreatectomy, or distal pancreatectomy).
• Palliative surgery or stent placement to bypass blocked areas in ducts or the small intestine.
• Some patients may also receive chemotherapy and chemoradiation to shrink the tumor to allow for surgery.
• Clinical trials
• Palliative therapy can be started at any stage of disease.

Treatment of Metastatic or Recurrent Pancreatic Cancer

Treatment of pancreatic cancer that has metastasized or recurred may include the following:

• Chemotherapy with or without targeted therapy such as erlotinib or olaparib.
• Clinical trials of new anticancer agents with or without chemotherapy.