Chemotherapy for pancreatic

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1 Chemotherapy for pancreatic cancer 1 Chemotherapy for pancreatic cancer This information is from the booklet Understanding pancreatic cancer. You may find the full booklet helpful. We can send you a free copy see page 5. Contents Chemotherapy Chemotherapy after surgery Chemotherapy for advanced pancreatic cancer Side effects More information and support Chemotherapy Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is one of the most commonly used treatments for pancreatic cancer. Chemotherapy may be given: after surgery to reduce the chance of the cancer coming back. This is called adjuvant chemotherapy. if surgery isn t possible to shrink the cancer, relieve symptoms and improve survival. This is called palliative chemotherapy. to shrink a cancer before surgery. This is called neoadjuvant chemotherapy. This may be done as part of a clinical trial for pancreatic cancer. Sometimes, chemotherapy is given with radiotherapy. This is known as chemoradiation. If it is given with radiotherapy before surgery, it is called neoadjuvant chemoradiation. This would usually be as part of a clinical trial. Your doctor or specialist nurse can give you more information about chemoradiation.

2 Chemotherapy for pancreatic cancer 2 Some chemotherapy drugs are given as tablets, but most are given by injection into a vein (intravenously). Intravenous chemotherapy can be given: into a fine tube (cannula) in a vein in your arm or hand through a flexible plastic tube (central line) that sits in a vein just under your collarbone at the top of your chest through a flexible plastic tube (PICC line) that goes into a large vein in the bend of your elbow into an implantable port (portacath) that has an opening (port) under the skin on your chest or arm going into a vein. We can send you more information about central lines, PICC lines and implantable ports. We also have animations on our website that explain how the lines are put in. Some types of chemotherapy are given through a small portable pump, which is attached to your line or port. A controlled amount of the drug is given into the bloodstream over a set period of time. This means that you can go home with the pump, and spend less time in hospital. Whether chemotherapy is given as tablets or into a vein, the drugs are absorbed into the blood and carried all round the body. The chemotherapy then destroys cancer cells wherever they are in the body. Chemotherapy is usually given as several sessions of treatment. Each treatment is followed by a rest period of a week or two to allow your body to recover from any side effects. The treatment and the rest period together make up a cycle of treatment. The number of cycles you have will depend on the drugs that are used, and how well the treatment is working. This is checked by your doctor at regular appointments. Most people can have their chemotherapy as an outpatient. Chemotherapy after surgery If you re having chemotherapy after surgery to remove the cancer, the treatment will usually last for about six months. The chemotherapy drug that s most commonly used for cancer of the pancreas is gemcitabine (Gemzar ). It is given as a drip into a vein (intravenous infusion) over 30 minutes. Gemcitabine Carol is usually given once a week for three weeks followed by a rest every fourth week. These four weeks make up a cycle of treatment and you will usually have six cycles of treatment. Another drug that may be used after surgery is fluorouracil (5FU). It is given intravenously or as tablets. The fluorouracil tablet is called capecitabine.

3 Chemotherapy for pancreatic cancer 3 Chemotherapy for advanced pancreatic cancer Gemcitabine is sometimes used in advanced pancreatic cancer. It can be given on its own or with another chemotherapy drug. This may be capecitabine or another drug called paclitaxel albumin (Abraxane ). Your doctor will talk to you about what drugs are available and suitable for you. Gemcitabine and paclitaxel albumin (Abraxane ) Gemcitabine may be given with another chemotherapy drug called paclitaxel albumin. Paclitaxel albumin is given as a drip into a vein, usually over half an hour. Like gemcitabine, it will usually be given once a week for three weeks, followed by a rest every fourth week. These four weeks make up a cycle of treatment. Your doctor or nurse will tell you more about this and the number of cycles of gemcitabine and paclitaxel albumin you are likely to have. FOLFIRINOX Sometimes, a combination of drugs called FOLFIRINOX may be given. It is made up of folinic acid (leucovorin) and the chemotherapy drugs fluorouracil (5FU), irinotecan and oxaliplatin. Folinic acid is not a chemotherapy drug, but is often given with 5FU as it s been shown to make it work better. A recent study found that FOLFIRINOX may help to control advanced pancreatic cancer for longer than standard treatment with gemcitabine. However, FOLFIRINOX can cause severe side effects so it is only suitable for people who are well enough to cope with these. Each cycle of treatment lasts for two weeks. On the first day of each cycle you re given folinic acid, 5FU, irinotecan and oxaliplatin intravenously. The nurse then attaches a small portable pump to your line or port for you to go home with. The pump will give you continuous chemotherapy with 5FU for the next two days. After this, it s disconnected from your line and you have a rest from chemotherapy for 11 days. This makes up a cycle of treatment. You may be given up to 12 cycles of treatment over about six months. Other drugs Other combinations of drugs, or new drugs, may be used to treat pancreatic cancer. Sometimes, this will be as part of cancer research trials. Treatments called targeted therapies are also being researched in cancer trials. These treatments interfere with the way that cancer cells grow. Research trials are carried out to try to improve the results of treatment for pancreatic cancer.

4 Chemotherapy for pancreatic cancer 4 Side effects Chemotherapy drugs may cause side effects, but they can also make you feel better by relieving the symptoms caused by the cancer. Most people have some side effects but these can usually be well controlled with medicines. The side effects will usually go away once the treatment has finished. Treatment with a combination of chemotherapy drugs tends to cause more severe side effects than treatment with a single chemotherapy drug. You can talk to your doctor or nurse about what to expect from the treatment that s planned for you. We can send you further information about the chemotherapy drugs mentioned here and their side effects. We can also give you advice about what you can do to reduce or control these side effects. We also have a booklet called Understanding chemotherapy with more details.

5 Chemotherapy for pancreatic cancer 5 More information and support More than one in three of us will get cancer. For most of us it will be the toughest fight we ever face. And the feelings of isolation and loneliness that so many people experience make it even harder. But you don t have to go through it alone. The Macmillan team is with you every step of the way. Visit macmillan.org.uk or call us on , Monday to Friday, 9am to 8pm. You can order a copy of Understanding pancreatic cancer, or any other cancer information, from be.macmillan.org.uk or by calling us. Hard of hearing? Use textphone , or Text Relay. Speak another language? We have telephone interpreters. We provide information in a range of languages and formats. Visit macmillan.org.uk/otherformats or call us. We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or third-party information or websites included or referred to in it. Macmillan Cancer Support Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ Revised in Novemver Next planned review in 2018.

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