Sidney Kimmel Comprehensive Cancer Center

Chemotherapy & Radiation Therapy

Chemotherapy and radiation therapy can be given:

  • To patients who are candidates for surgery (stage I or II). These therapies can be given before surgery (neoadjuvant therapy) or after surgery (adjuvant therapy). In these settings, chemotherapy can be given alone or in combination with radiation therapy.
  • To patients with minimally locally advanced pancreatic cancer (stage III) who are not candidates for surgery. The goal here is to shrink the tumor so that the tumor becomes small enough that the patient can be a candidate for surgery.
  • To patients with extensively locally advanced but not metastatic pancreatic cancer. In this situation, radiation therapy can provide good local (in the area of the pancreas) control of the cancer, and it can alleviate a number of symptoms caused by the cancer such as pain.

There have been a number of advances in the way radiation therapy is delivered, including "intensity-modulated radiation therapy." These advances allow the radiation oncologist to deliver higher doses of radiation to focused areas with cancer with less damage to the surrounding normal structures. In some instances the radiation can also be given over a shorter interval of time.

What is Chemotherapy?

Chemotherapy is a systemic treatment (it treats your entire body) that typically involves combinations of drugs given intravenously (given into the veins). Although patients and oncologists have many options, there are two main chemotherapy drug combinations. These are:

  • FOLFIRINOX is the combination of four drugs- Leucovorin Calcium (FOL), 5-Fluorouracil (F), Irinotecan Hydrochloride (IRIN) and Oxaliplatin (OX) .5-fluorouracil (5FU) is a "thymidylate synthase inhibitor" and it functions by blocking the synthesis of the pyrimidine thymidine, a building block for DNA. FOLFIRINOX treatment has been shown to prolong life in patients with pancreatic cancer, but it does have a number of side effects, including low white blood cell count (neutropenia), low platelet counts (thrombocytopenia), diarrhea and sensory neuropathy.
  • GEM ABRAXANE is the combination of two drugs- Gemcitabine and Abraxane. Gemcitabine (also known under the brand name Gemzar) is a "nucleoside analog," and when combine with abraxane has also been shown to improve overall survival.

Often patients start with one drug combination. If the tumor responds, they stay on it. If the tumor isn't responding as nicely as the oncologist would like, the patient can be switched to the other drug combination. So, unlike ten years ago, patients have real options!

Both of these drug combinations have been shown to prolong life in patients with metastatic pancreatic cancer.

Dr. Daniel Laheru talks about chemotherapy for pancreatic cancer.

Neoadjuvant Therapy

Some patients, particularly those with borderline resectable pancreatic cancer, may be treated with chemotherapy or chemoradiation therapy before surgery. This treatment before surgery is called neoadjuvant therapy, and it serves two purposes.

  1. It may shrink the tumor, slightly increasing the likelihood that the tumor can be completely removed surgically.
  2. Some patients given neoadjuvant therapy will be found to have metastatic cancer during the period of neoadjuvant treatment. This metastatic cancer was presumably present at the start of neoadjuvant therapy, it just couldn't be detected. These patients will be deemed unresectable and spared the complications of surgery that is unlikely to have benefited them.

Adjuvant Therapy

Chemotherapy, or a combination of chemotherapy and radiation therapy, can be given after surgery to reduce the risk that the cancer recurs after surgery. This is called adjuvant therapy.

Radiation Therapy

In addition to the scenarios described above, radiation therapy in combination with chemotherapy is often given to patients with locally advanced but not metastatic pancreatic cancer. In this situation, radiation therapy can provide good local (in the area of the pancreas) control of the cancer, and it can alleviate a number of symptoms caused by the cancer such as pain.

There have been a number of advances in the way radiation therapy is delivered, including "intensity-modulated radiation therapy." These advances allow the radiation oncologist to deliver higher doses of radiation to the areas with cancer with less damage to the surrounding normal structures. In some instances the radiation can also be given over a shorter interval of time.

Dr. Joseph Herman talks about the role of radiation therapy in pancreatic cancer.