Pancreatic Cancer Treatment Options

Thanks to clinical research and participants in clinical trials, a variety of treatments are available for pancreatic cancer today. Most patients receive a combination of treatments. The set that’s right for you depends mainly on the following:

• The location of the tumor in your pancreas
• The stage of cancer, which is primarily based on whether surgery is possible
• Whether the disease has spread outside of the pancreas
• Your age and general health condition

Pancreatic Cancer Treatments Include:

The right treatments for you will be discussed among several specialists: the medical oncologist – who tends to lead the treatment team, the surgical oncologist, the radiation oncologist, and the gastroenterologist, who is likely the doctor who diagnosed the cancer. 

Compass Oncology's treatment team includes a hepato-pancreato-biliary (HPB) surgical oncologist. She is highly specialized in surgeries for complex conditions, including pancreatic cancer, pancreatitis, and other pancreatic disorders.

Pancreatic Surgical Oncology

One key factor in the treatment plan is whether surgery to remove the cancer is possible. The HPB surgeon will review test results and images to determine if the cancer is resectable, which means it can be surgically removed. In some cases, it’s partially resectable, and in other patients, it can’t be removed surgically.

If surgery is possible, there are typically two types used for pancreatic cancer:

• Potentially curative surgery. Especially when pancreatic cancer is found early, it can be surgically removed, giving the best opportunity for a full recovery.
• Palliative surgery. If the cancer is too widespread to be fully removed the surgeon may recommend a procedure that will relieve symptoms.

Ablation or Embolization Treatments for Pancreatic Cancer

Ablation and embolization are non-surgical treatments that may be used to destroy tumors. These methods aren’t used frequently for cancer of the pancreas, although they can be helpful for patients who cannot undergo surgery or if cancer has spread to other organs, especially into the liver. 

Ablation refers to treatments that destroy tumors, usually with extreme heat or cold. Side effects after ablation therapy may include abdominal pain, infection, and internal bleeding. 

Embolization injects substances into an artery to attempt to block the blood flow to cancer cells. This causes them to die. Side effects after embolization might include pain in the abdomen, fever, nausea, infection, and blood clots in nearby blood vessels.

Radiation Therapy for Pancreatic Cancer

Radiation therapy uses high-energy rays to kill cancer cells. It can be given along with other treatments, including chemotherapy. Radiation might also be used for pancreatic cancer after surgery to reduce the chance of cancer returning. 

The radiation comes from a large machine that aims beams of radiation at the cancer in the abdomen. Typically, patients go to a hospital or clinic 5 days a week for several weeks to receive radiation therapy. Each session takes about 30 minutes.

Although radiation therapy is painless, it may cause other side effects. The side effects include skin irritation, nausea, diarrhea, or feelings of fatigue.

Chemotherapy for Cancer of the Pancreas

Quite often, pancreatic cancer is detected after it’s spread to the lymph nodes. By entering the lymph system, the cancer cells float throughout the body. Chemotherapy is used to kill cancer cells that are present, whether in the primary location or in other areas of the body. Most people with pancreatic cancer get chemotherapy.

For early pancreatic cancer, chemotherapy is usually given after surgery (adjuvant), but in some cases, it’s given before surgery (neoadjuvant). For advanced cancer, chemotherapy is used alone, with targeted therapy, or with radiation therapy to shrink the tumor without performing surgery.

Chemotherapy for pancreatic cancer is usually given with an IV and is given in cycles. This means you’ll have treatments every few weeks.  

Every treatment cycle is followed by a period of rest. The number of treatment cycles and how long the rest period lasts depend on the anticancer drugs used and the patient’s response.

Some drugs used for pancreatic cancer also may cause tingling or numbness in your hands and feet.

Targeted Therapy to Treat Pancreatic Cancer

People with pancreatic cancer who can’t have surgery may receive a type of drug called targeted therapy. Unlike chemotherapy, targeted therapy works by focusing on the specific genetic changes causing the pancreatic cancer cells to grow. 

Biomarker Testing to Determine Genetic Changes

Before recommending targeted therapy as a treatment option, your oncologist will perform biomarker testing, also known as genomic testing. These tests examine a tumor tissue sample to determine the presence of abnormal proteins or genetic mutations.

Biomarker testing is a crucial step in personalized pancreatic cancer care, allowing your oncology team to specifically identify and administer drugs that directly target the genetic mutations within the tumor. If no mutations are detected, your care team will suggest alternative pancreatic cancer treatment options that may be effective for you.

Targeted Therapies Based on Specific Genetic Mutations

Common targeted therapy treatment approaches for pancreatic cancer based on genetic mutations include:

• Using a BRAF inhibitor to target changes in the BRAF gene, specifically the BRAFV600E mutation.
• NTRK inhibitors, which target changes in the NTRK gene.
• A RET inhibitor, which targets changes in the RET gene.
• The use of a KRAS inhibitor to target changes in the KRAS gene, specifically the KRAS G12C mutation.
• An EGFR inhibitor, which targets EGFR, a protein that typically aids in cell growth.
  PARP inhibitor treatment to target any identified changes in the BRCA1 or BRCA2 gene.

These drugs are usually taken orally and often have different side effects than chemotherapy, such as diarrhea, nausea, vomiting, rash, and shortness of breath.

Immunotherapy for Pancreatic Cancer

Immunotherapy uses medications to alert the body's immune system to recognize and fight cancer cells effectively. It is a relatively new treatment method for pancreatic cancer and is currently only used in certain cases, such as in patients with locally advanced, metastatic, or recurrent pancreatic cancers that cannot be removed with surgery (unresectable). 

Drugs called checkpoint inhibitors are an option for treating pancreatic cancers in patients whose pancreatic cancer cells have tested positive for specific gene changes, such as high microsatellite instability (MSI-H) or mismatch repair deficiency (dMMR). 

A PD-1 inhibitor is another type of drug that may be used to treat pancreatic cancer. PD-1 inhibitors target PD-1, a checkpoint protein on T cells of the immune system. Normally, PD-1 helps prevent these cells from attacking normal cells in the body. By blocking PD-1, this drug enhances the immune response against pancreatic cancer cells, resulting in the shrinkage of the tumor. 

Patients receive this medication as an intravenous (IV) infusion every 2 or 3 weeks. Side effects vary based on the type of immunotherapy received but can include fatigue, cough, loss of appetite, nausea, joint pain, itching, skin rash, constipation, and diarrhea.

Palliative Care for Pancreatic Cancer

If the pancreatic cancer has spread too far to be removed completely, the oncologist may recommend palliative care in addition to other treatments. Palliative care aims to help manage symptoms, such as jaundice, nausea, and vomiting, that can occur when the growing cancer blocks the bile duct. Palliative care to help relieve symptoms and improve quality of life can include:

• Endoscopic stent placement: If the tumor is blocking the bile duct, a stent (a thin tube) might be inserted through a catheter to drain the built-up bile in the area.
• Bypass surgery: This procedure reroutes the bile flow from the bile duct directly into the small intestine, bypassing the pancreas. Typically, this requires a large incision (cut) in the abdomen. However, there are times it can be done laparoscopically.
• Radiation or chemotherapy: Palliative radiation therapy or palliative chemotherapy may be administered to help relieve pain by shrinking the tumor. Still, the primary goal is not to completely kill the tumor(s).
  Medications: Morphine or similar drugs (opioids) can help control the pain associated with pancreatic cancer. An injection of medicine to block nerves in the abdomen might also be recommended. 

Clinical Trials for Pancreatic Cancer in Portland & Vancouver

Cancer research trials are a very important part of improving the treatment available to pancreatic cancer patients. You may be eligible to participate in a clinical trial. Your oncologist will talk to you if one is available that is a good fit. You will still receive your treatments at the Compass Oncology cancer centers from our oncologists, plus you’ll have access to the most advanced and latest treatments available to treat pancreatic cancer. You’re never added to a trial without your consent. If this is an option for you, we encourage you to ask as many questions as you’d like and then choose what you’re most comfortable with. 

Pancreatic Cancer Care and Treatment at Compass Oncology

If you or a loved one has received a diagnosis of pancreatic cancer, our oncologists are ready to guide you through this journey. We provide patients in the Portland and Vancouver areas with the latest pancreatic cancer treatment options based on their unique cancer type. Our nurses and other team members will help you through each of the treatments with tips on what to expect and how to handle side effects.

Our oncologists also provide second opinions before starting a cancer treatment plan. This will ensure you’re informed about your treatment options and feel confident about the plan you choose. Request an appointment with an oncologist at Compass Oncology to discuss a personalized treatment plan.