The treatment of pancreatic cancer is tailored to each individual and may consist of surgery, precision cancer medicines, chemotherapy, and radiation therapy. The specific treatment can depend on the stage and genomic profile of the cancer. Optimal treatment will often require more than one therapeutic approach and is likely to involve several different types of physicians. These physicians may include a gastroenterologist, a surgeon, a medical oncologist, a radiation oncologist, or other specialists. Care must be carefully coordinated between the various treating physicians.1
Surgery for Pancreatic Cancer
Surgery for cancer of the pancreas is performed in order to remove the cancer and learn additional information about the cancer. Surgery can be performed with curative intent for some patients with earlier stage cancers localized to the pancreas. Patients with more-advanced cancer may undergo surgery for reduction of symptoms and prevention of obstruction of the bile duct. Obstruction of the bile duct is a common complication of pancreatic cancer that may lead to jaundice (a yellow discoloration of the skin). Less frequently, surgery is performed to treat or prevent obstruction of the stomach outlet.
Radiation Therapy for Pancreatic Cancer
Radiation therapy or radiotherapy uses high-energy rays to damage or kill cancer cells by preventing them from growing and dividing. Similar to surgery, radiation therapy is a local treatment and is not useful in eradicating cancer cells that have already spread to other parts of the body. Radiation therapy may be externally or internally delivered. External radiation delivers high-energy rays directly to the tumor site from a machine outside the body. Internal radiation, or brachytherapy, involves the implantation of a small amount of radioactive material in or near the cancer.
Radiation therapy is an important treatment modality for patients with advanced pancreatic cancer but is rarely used alone. Optimal treatment of patients with pancreatic cancer often requires more than one therapeutic approach. Radiation therapy is usually given with chemotherapy, which can improve the average duration of survival for patients with localized and locally advanced disease.
Systemic Therapy: Precision Cancer Medicine, Chemotherapy, and Immunotherapy
Systemic therapy is any treatment directed at destroying cancer cells throughout the body. Some patients with early stage cancers already have small amounts of cancer that have spread away from the pancreas that cannot be treated with surgery or radiation. These patients require systemic treatment to decrease the chance of cancer recurrence. More advanced cancers that cannot be treated with surgery and radiation can only be treated with systemic therapy. Systemic therapies commonly used in the treatment of cancer include:
Precision Cancer Medicines
The purpose of precision cancer medicine is to define the genomic alterations in the cancers DNA that are driving that specific cancer. Precision medicines like “PARP inhibitors are now available for the treatment of pancreatic cancer patients with specific genomic alterations and patients should ask their doctor about whether testing is appropriate.8,9,10,11,12,13
Chemotherapy
Chemotherapy is any treatment involving the use of drugs to kill cancer cells. Cancer chemotherapy may consist of single drugs or combinations of drugs, and can be administered through a vein, injected into a body cavity, or delivered orally in the form of a pill. Chemotherapy is different from surgery or radiation therapy in that the cancer-fighting drugs circulate in the blood to parts of the body where the cancer may have spread and can kill or eliminate cancers cells at sites great distances from the original cancer. The drugs are usually given in cycles so that a recovery period follows every treatment period.
Several chemotherapy medications administered alone or in combination can modestly prolong survival of patients with various stages of pancreatic cancer including the following:2,3,4,5,6,7
- Gemzar® (gemcitabine)
- Onivyde
(irinotecan liposome injection) - Eloxatin® (oxaliplatin)
- Abraxane® (nab-paclitaxel)
- Tarceva® (erlotinib)
- Xeloda (capecitabine)
- 5-FU (fluorouracil)
- Taxol (paclitaxel)
- Sutent (sunitinib)
New treatment strategies are sorely needed for this difficult to treat cancer and current emphasis is on the development of new precision cancer medicines.
In order to learn more about the most recent information available concerning the treatment of pancreatic cancer, click on the appropriate stage.
Stage I: Cancer is confined to the pancreas.
Stage II: Cancer may extend to the duodenum, bile ducts, or fat surrounding the pancreas, but does not invade any local lymph nodes.
Stage III: Cancer invades one or more of the local lymph nodes and has extended to major blood vessels.
Stage IV: Cancer has spread to the stomach, bowel, or distant locations in the body, which may include the liver, lungs, bones, or other sites.
Recurrent/Relapsed: The pancreatic cancer has been detected or returned (recurred/relapsed) following an initial treatment.
References
1 American Cancer Society: Cancer Facts and Figures 2017. Atlanta, Ga: American Cancer Society, 2017.
2 National failure to operate on early stage pancreatic cancer. Annals of Surgery. 2007;246:173-180.
3 Burris HA III, Moore MJ, Andersen J, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: A randomized trial. J Clin Oncol1997;15:2403-2413.https://news.cancerconnect.com/pancreatic-cancer/onivyde-approved-for-pancreatic-cancer-pqIL4MxNvkWiA8YdomMu-g/
4 https://news.cancerconnect.com/pancreatic-cancer/eloxatin-folinic-acid-fluorouracil-improve-survival-in-pancreatic-cancer-n8BagXvTSkOn_b84vtOSTw/
5 Von Hoff DD, Ervin T, Arena FP, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. New England Journal of Medicine. 2013; 369(18): 1691-703.
6 Neoptolemos J, Palmer D, Ghaneh P, et al. ESPAC-4: A multicenter, international, open-label randomized controlled phase III trial of adjuvant combination chemotherapy of gemcitabine (GEM) and capecitabine (CAP) versus monotherapy gemcitabine in patients with resected pancreatic ductal adenocarcinoma. J Clin Oncol 34, 2016 (suppl; abstr LBA4006)
7 Pancreatic Cancer Action. Facts and statistics. Accessed February 2019 from https://pancreaticcanceraction.org/about-pancreatic-cancer/medical-professionals/stats-facts/facts-and-statistics/
8 https://news.cancerconnect.com/pancreatic-cancer/lynparza-first-promising-new-drug-to-treat-pancreatic-cancer-in-years-H6BzHID6FUiWnbz7R-Oe8A/
9 Safran H, Ramanathan R, Schwartz J, King T, et al. Herceptin and Gemcitabine for Metastatic Pancreatic Cancers That Overexpress her-2/neu. Proceedings from the 37th Annual Meeting of the American Society of Clinical Oncology 2001, San Francisco CA, Abstract https://news.cancerconnect.com/pancreatic-cancer/pancreatic-cancer-treatment-and-management-m9u3y7zBbEmKlDaxFwpD5A/
10 https://news.cancerconnect.com/pancreatic-cancer/larotrectinib-demonstrates-76-response-rate-in-trk-fusion-pancreatic-cancer-RUnOonFcEEi9IU_QyzOfVw/
11 Cascinu S, Berardi R, Labianca R, et al. Cetuximab plus gemcitabine and cisplatin compared with gemcitabine and cisplatin alone in patients with advanced pancreatic cancer: a randomised, multicentre, Phase II trial. Lancet Oncology. 2008;9:39-44.
12 Toubaji A, Achtar M, Provenzano M et al. Pilot study of mutant ras peptide-based vaccine as an adjuvant treatment in pancreatic and colorectal cancers.Cancer Immunol Immunother. 2008 Feb 23.
13 https://www.astrazeneca.com/content/astraz/media-centre/press-releases/2019/lynparza-significantly-delayed-disease-progression-as-1st-line-maintenance-treatment-in-germline-brca-mutated-metastatic-pancreatic-cancer-26022019.html