When is this procedure indicated?
In patients with pancreatic cancer, chemotherapy is recommended for patients with resectable cancer before or after surgery, for patients with unresectable cancer, and for patients who have developed distant metastases. Among patients with resectable cancer, chemotherapy may be provided:
- before surgery (neoadjuvant chemotherapy) with the aim of reducing the size of the neoplasm, allowing greater resectability and eliminating the possible presence of distant neoplastic cells not visible with instrumental investigations;
- after surgery (adjuvant chemotherapy) with the aim of reducing the risk of recurrence and increasing survival.
For patients with localized but unresectable pancreatic cancer or who develop distant metastases, chemotherapy is the standard of care.
How is it performed?
Adenocarcinoma of the pancreas is a treatment-resistant tumor. In our Institute specific chemotherapy regimens have been developed that have improved the results of standard treatment, both in terms of efficiency and tolerability. There are also active clinical trials that allow to offer the patient more therapeutic options.
Surgery can be preceded by a few cycles of chemitherapy to allow greater resectability and eliminate distant micrometastases. At our Institute we conduct a clinical trial with the goal of defining the best chemotherapy scheme to be used and the duration of treatment. Patients operated for pancreatic cancer and in good clinical condition can receive post-operative (adjuvant) chemotherapy based on gemcitabine or fluoropyrimidines, oxaliplatin and irinotecan (m FOLFIRINOX) for 6 months. It should be initiated within 6 to 8 weeks after surgery.
Patients with localized but unresectable pancreatic cancer and distant metastases in good clinical condition are recommended combination chemotherapy based on nab-paclitaxel (abraxane) and gemcitabine (AG; or PAXG: cisplatin, nab-paclitaxel, capecitabine and gemcitabine) or based on fluoropyrimidines irinotecan and oxaliplatin (FOLFIRINOX). Weekly gemcitabine administration is indicated especially in elderly patients with suboptimal general clinical conditions. In patients with disease progression after these treatments, an additional line of chemotherapy other than the previous one is reserved for patients in good clinical condition. In this case patients can be treated with a monochemotherapy or a combination of two drugs including fluoropyrimidine, oxaliplatin, irinotecan.