Chemotherapy (also called systemic therapy) is a drug or combination of drugs given intravenously or orally. These drugs are carried throughout the body to kill cancer cells wherever they are. Chemotherapy has been shown to extend survival for patients in a variety of situations:
- In addition to surgery or radiation therapy for tumors that are confined within the pancreas
- As a primary treatment for inoperable tumors that are confined within the pancreas
- For treatment of metastatic pancreatic tumors that have spread from the pancreas to other parts of the body
Medical oncologists at Memorial Sloan-Kettering are experienced in selecting the most effective chemotherapy drug or combination or medications for each individual patient.
We are also leaders in the development of new treatments for pancreatic cancer. This means that choosing Memorial Sloan-Kettering for your cancer care may offer you access to clinical trials of new chemotherapy drugs, targeted therapies, or drug combinations that are not available in most other hospitals.
Chemotherapy for Localized Pancreatic Cancer
Gemcitabine (Gemzar®) is a standard chemotherapy drug for patients who have had surgery for tumors that are confined within the pancreas. This medication is commonly given in combination with other chemotherapy drugs to control the spread of cancerous cells from the pancreas to other parts of the body (metastasis), and to improve survival. A recent study demonstrated that treating patients with gemcitabine after surgery significantly increased survival.(1)
Chemotherapy for Inoperable or Metastatic Pancreatic Tumors
Gemcitabine-based chemotherapy, in combination with radiation therapy, is routinely given to people with localized or metastatic tumors that are inoperable. This approach can help to reduce the rate of tumor growth and extend life.
Medical oncologists at Memorial Sloan-Kettering are evaluating the effectiveness of a multi-drug chemotherapy regimen called FOLFIRINOX. The regimen, which includes 5-FU, leucovorin, irinotecan, and oxaliplatin, may be more effective in shrinking tumors, controlling disease progression, and extending life than gemcitabine. However, this treatment is often associated with additional side effects, and is only appropriate for certain patients with pancreatic cancer.
Additional clinical trials at Memorial Sloan-Kettering are evaluating the effectiveness of standard treatments in combination with novel medications, including drugs that interfere with the development of pancreatic tumors or the supportive matrix in which pancreatic cancer cells live.
Currently, many patients receive chemotherapy after surgery. However, researchers are beginning to investigate whether giving chemotherapy before surgery (also called neoadjuvant chemotherapy) may have benefits for some people with the disease. This approach has already been shown to be effective in the treatment of other types of cancer.
Our doctors are studying the effectiveness of neoadjuvant chemotherapy, and how to determine which patients are most likely to benefit from this approach. Using chemotherapy before surgery may help to reduce the size of more-advanced tumors before an operation, so that they can be removed with better outcomes.
Toward Personalized Medicine: Cancer Stem Cell Diagnostics
Medical oncologists at Memorial Sloan-Kettering are conducting clinical research to test whether pancreatic cancer stem cells could be used to predict which chemotherapy regimens will be most effective for individual patients. Although this new approach is still experimental and is not currently used in treatment, your doctor may ask if you would like to participate in this research.
Cancer stem cells are a type of cancer cell that can seed the growth of new tumors. Evidence suggests that some cancers return after chemotherapy because cancer stem cells are resistant to many drugs. When cancer stem cells are not eliminated, they can cause new tumors to grow in the pancreas or in other parts of the body.
If you participate in this research, you will undergo a standard blood test. From this sample, pathologists will isolate the pancreatic stem cells and examine their DNA. The goal of our current research is to identify specific genetic profiles that could help to predict which type of chemotherapy will be most effective against different subtypes of pancreatic cancer. In the future, the test could also help medical oncologists develop new, more-effective drugs and choose new treatments if the cancer returns after treatment.
New Treatments for Patients with BRCA1 or BRCA2 Mutations
Memorial Sloan-Kettering is also working to develop targeted treatments for people with a higher genetic risk of developing pancreatic cancer. About 5 to 8 percent of patients have a mutation in their BRCA1 or BRCA2 genes. This mutation is more common in patients with a strong family history of cancer and in people of eastern European or Ashkenazi Jewish descent.
Our medical oncologists are leading research to study a new class of drugs called PARP inhibitors, in combination with standard chemotherapy, in patients with a BRCA mutation. PARP inhibitors may prevent chromosomal repair within pancreatic cancer cells, allowing them to die. These drugs have shown promise in treating women with breast and ovarian cancer, diseases in which BRCA mutations commonly occur.