Treatment
Systemic Therapy
Chemotherapy, immunotherapy, and clinical trials for pancreatic cancer: how they work, when they are used, and what to expect.
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Treatment
Chemotherapy
Chemotherapy uses medicines that travel through the bloodstream to prevent cancer cells from growing and spreading. It can be given before surgery (neoadjuvant), after surgery (adjuvant), or as the primary treatment when surgery is not an option.
Chemotherapy drugs can be given intravenously (through a vein) or by mouth, usually as outpatient treatment. The most commonly used agents in pancreatic cancer are fluorouracil (5-FU) and gemcitabine. The two most common combination regimens are FOLFIRINOX and Gem-Abraxane (gemcitabine/nab-paclitaxel).
Chemotherapy may be given alone or in combination with surgery, targeted therapy, immunotherapy, and/or radiation. Genetic testing results can influence which chemotherapy regimen is most appropriate.
Treatment
Immunotherapy
Immunotherapy helps the body's own immune system recognize and attack cancer cells.
While immunotherapy has shown success in several other cancers, its benefit in pancreatic cancer has so far been limited; most pancreatic tumors do not respond well to immunotherapy alone.
An important exception is patients whose tumors have a specific genetic feature called MSI-H (microsatellite instability-high) or dMMR (mismatch repair deficiency); these tumors can respond well to immunotherapy. This is one reason genetic testing of the tumor is recommended for all patients. Clinical trials are actively testing new approaches combining immunotherapy with chemotherapy, radiation, or targeted drugs.
Treatment
Mediport (Port-a-Cath)
Because many chemotherapy treatments are given through an IV, doctors often place a small device called a mediport under the skin of the chest.
The mediport connects to a thin tube leading to a large vein, allowing nurses to give chemotherapy and draw blood without repeated needle sticks. The port is placed during a short outpatient procedure with light sedation, and can stay in place for as long as chemotherapy is needed. It must be flushed regularly to keep it working properly.
Research
Clinical Trials
Clinical trials investigate new treatments or new combinations of treatments, providing early access to innovative therapies designed to improve effectiveness and minimize side effects.
In the fight against pancreatic cancer, clinical trials benefit current participants and future patients while advancing research. Eligibility varies widely by stage and tumor type. If you are interested in exploring available trials, ask your doctor which trials you may be eligible for. Your care team at Mount Sinai has access to a wide variety of open trials.
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Treatment planning for pancreatic cancer is complex. A multidisciplinary team approach at a high-volume center leads to better outcomes.