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Medical Author:

Timothy Kuo, MD

Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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The following chemotherapy drugs may be included as part of the treatment regimen depending on the stage of pancreatic cancer:

• S-1, a new chemotherapy oral agent, may replace gemcitabine (see below) as the most effective chemotherapeutic drug to treat pancreatic cancer.
• Gemcitabine (Gemzar): Gemcitabine is given intravenously once a week for 7 weeks (or until toxicity limits treatment), and then no treatment is given for 1 week. Then, cycles are resumed of gemcitabine once each week for 3 weeks in a row followed by 1 week off. This drug has direct effects on the cancer cells and is usually given alone for the treatment of metastatic pancreatic cancer. Side effects include fatigue, nausea, increased risk of infection because of its effects on the immune system, and anemia.
• Fluorouracil (5-FU): Fluorouracil is usually given intravenously as a continuous infusion using a medication pump. This drug has direct effects on the cancer cells and is usually used in combination with radiation therapy because it makes cancer cells more sensitive to the effects of radiation. The side effects include fatigue, diarrhea, mouth sores, and hand-and-foot syndrome (redness, peeling, and pain on the palms of the hands and the soles of the feet).
• Capecitabine (Xeloda): Capecitabine is given orally and is converted by the body to a compound similar to 5-FU. Capecitabine has similar effects on the cancer cells as 5-FU and is also generally used in combination with radiation therapy. Side effects are similar to intravenous continuous infusion of 5-FU.

Currently, many other drugs are being investigated for the treatment of pancreatic cancer, generally in combination with gemcitabine. These drugs include bevacizumab, vatalanib, cetuximab, and erlotinib. Whether any of these drugs will improve the results obtained with gemcitabine alone is not yet known. Other drugs like S-1 may be found to increase survival times. Enrollment in clinical trials is encouraged.

Medications are available to alleviate the side effects of the treatments. If side effects occur, an oncologist should be notified so that they can be addressed promptly. An oncologist also monitors blood and urine for signs of toxicity.

Pancrelipase (pancreatic enzyme replacement) may be given if the function of the pancreas is impaired, usually after the surgical removal of a portion of the pancreas. This oral medication is taken with meals to aid in the digestion of food and in the prevention of steatorrhea.

Pain may be associated with pancreatic cancer, and a variety of pain medications exist to help control any discomfort. Good communication with the oncologist and nurses allows for optimal management of pain.

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