Treatment options for pancreatic cancer vary based on the cancer stage and are also influenced by a patient’s age, overall health, and personal preferences. Pancreatic cancer may be treated by one or a combination of interventions, including surgery, radiation, chemotherapy, targeted therapy, or immunotherapy.
Surgery
Fewer than 1 in 5 cases of pancreatic cancer are caught when the cancer is confined to the pancreas, and of those, not all can be treated with surgery alone.
The main types of surgery are a Whipple procedure or a pancreatectomy. In a Whipple procedure, the surgeon removes the head of the pancreas, a part of the small intestine called the duodenum, and the gallbladder and bile duct. The surgeon then reconnects the digestive tract and biliary system. A pancreatectomy is the removal of part or all of the pancreas.
Surgery may be followed or preceded by chemotherapy and radiation to reduce the risk of recurrence or preceded by these interventions to shrink the tumor before attempting to remove it. Risks of surgery can include bleeding, digestive problems, and an increased risk of type 2 diabetes resulting from the loss of insulin production in the pancreas.
Chemotherapy
Chemotherapy is a systemic treatment (meaning it affects the entire body) in which drugs designed to kill cancer cells are delivered into the bloodstream intravenously. Chemotherapy is the first-line treatment for pancreatic cancer and may be used in conjunction with radiation, surgery, and other treatments.
Chemotherapy drugs approved to treat pancreatic cancer include:
- Folfirinox (combination of leucovorin calcium (folinic acid), fluorouracil, irinotecan hydrochloride, and oxaliplatin).
- gemcitabine and capecitabine (if Folfirinox is not tolerated)
- gemcitabine alone (in frail patients)
- gemcitabine and nab-paclitaxel (used to shrink tumors prior to surgery, when feasible)
Side effects of chemotherapy may include nausea and vomiting, hair loss, mouth sores, nerve pain, and infections, among others.
Radiation
With radiation therapy, a machine delivers high-energy rays to areas of the body where cancer has been found. These rays can help stop cancer cells from continuing to grow and spread.
External beam radiation therapy — the type most frequently used in pancreatic cancer — is usually given five days a week for two to five weeks. Each treatment lasts only a few minutes and may be used in conjunction with other therapies for pancreatic cancer.
External beam radiation is the most common type of radiation used to treat pancreatic cancer. Radiation side effects can include fatigue, nausea, and diarrhea.
Targeted Therapy
Targeted therapies for pancreatic cancer target specific genes or proteins in certain tumors with little to no damage to healthy cells. They can be given via injection, orally, or intravenously.
Targeted therapies approved for exocrine pancreatic tumors include:
- dabrafenib and trametinib (Tafinlar and Mekinist)
- entrectinib (Rozyltrek)
- erlotinib (Tarceva)
- fam-trastuzumab deruxtecan-nxki (Enhertu)
- larotrectinib (Vitrakvi)
- olaparib (Lynparza)
Targeted therapies approved for neuroendocrine pancreatic tumors include:
- everolimus (Afinitor)
- sunitinib (Sutent )
Because targeted therapies are more specific for cancer cells, they often cause fewer side effects than other treatments. When side effects do occur, they may include nausea, vomiting, rashes, and lowered blood cell counts. Side effects differ depending on the patient and the specific drug.
Immunotherapy
Immunotherapy, delivered intravenously or as an oral medication, enhances the immune system’s ability to attack cancer.
Most immunotherapy drugs are being studied in clinical trials and are not widely available for pancreatic cancer. One immune checkpoint inhibitor, pembrolizumab (Keytruda), has been approved by the U.S. Food and Drug Administration (FDA) to treat pancreatic cancer patients with certain genetic alterations.
Medication side effects can include swelling and numbness of hands and feet, hair loss, nausea, weight loss, fatigue, and autoimmune symptoms.