Chemotherapy for pancreatic cancer

What is it?

Chemotherapy consists in the administration of one or more substances capable of attacking the most rapidly multiplying cells, therefore particularly cancerous cells, during the process of replication.

When is this procedure indicated?

In patients with pancreatic cancer, chemotherapy is indicated in patients with resectable cancer before or after surgery, in patients with unresectable cancer, and in patients who have developed distant metastases.

In patients with resectable cancer, chemotherapy may be given:

  • before surgery (neoadjuvant chemotherapy) with the aim of reducing the size of the neoplasm, allow greater resectability and eliminate the possible presence of neoplastic cells at a distance not visible with instrumental investigations.
  • after surgery (adjuvant chemotherapy) with the aim of reducing the risk of recurrence and increasing survival

In 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 cancer. In our Institute, specific chemotherapy regimens have been developed that have improved the results of the standard treatment, both in terms of efficacy and tolerabilit. There are also active clinical trials to provide patients with more treatment options.

Surgery may be preceded by a few cycles of chemitherapy to allow for greater resectability and eliminate distant micrometatases. At our Institute, a clinical trial is carried out with the aim of defining the best chemotherapy scheme to be used and the duration of treatment.

Patients operated on for pancreatic cancer and in good clinical condition may receive postoperative (adjuvant) chemotherapy of gemcitabine or fluoropyrimidines, oxaliplatin, and irinotecan (m FOLFIRINOX) for 6 months. It should be started within 6-8 weeks of surgery.

In patients with localized but unresectable pancreatic cancer and distant metastases in good clinical condition, 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) is indicated. Administration of weekly gemcitabine is indicated especially in elderly patients and those 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 monochemotherapy or a two-drug combination that includes fluoropyrimidine, oxaliplatin, irinotecan.

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