What are the treatment options?

PANCREATIC CANCER

African-American Patient Guide
Educational Module

What are the treatment options?

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There is not a set way to treat pancreatic cancer. There are many possibilities for treatment plans, and none of these options are necessarily better than the other. It is important to remember that if you are offered surgery as an option, this is likely your best chance at a cure.

Surgery

About 15-20% of patients with tumors of the pancreas are eligible to have it removed with surgery.

The surgery that is most often used is the Whipple procedure. The Whipple procedure is a long and difficult surgery, but it has become safer. This is a tough surgery with a long recovery, but often gives people more time.

Surgery can lead to even better outcomes when it’s put together afterwards with other forms of treatment, like chemotherapy. Treatments also can be given before surgery – to give a small number of patients with apparently inoperable pancreatic cancer improved staging such that they may now be eligible for surgery.

Medical Treatment

There are many options for treatment of pancreatic cancer that can’t be removed using surgery or has come back after surgery. But there are no guidelines that are universally agreed upon. The reason that there are only general recommendations is because medical treatment is usually tailored to each individual. Everyone’s situation is unique.

Treatment for Locally Advanced Pancreatic Cancer

Since locally advanced pancreatic cancer is usually not removable with surgery when it is diagnosed, the initial treatment is usually chemotherapy. Radiation may also be used. Radiation can be given along with certain types of chemotherapy, like gemcitabine and capecitabine.

Chemotherapy (with or without radiation) can be used to shrink a tumor enough to allow some patients who were diagnosed with locally advanced pancreatic cancer to be able to have surgery. However, this only works for a small number of patients.

Treatment for Advanced/Metastatic Pancreatic Cancer

Treatment for patients with advanced or metastatic pancreatic cancer usually only includes chemotherapy or more experimental treatments.

There are multiple chemotherapy agents that are used in medical treatments for pancreatic cancer. 5-FU is a chemotherapy agent that helps kill cells. Gemcitabine is another example of a chemotherapy drug that can increase survival rates and seems to improve patients’ quality of life more than 5-FU alone or no treatment. Some treatments combine multiple drugs, which can give better results that gemcitabine but can also cause more side effects. An example of this is FOLFIRINOX, which has a mixture of four different chemotherapy drugs.

Sometimes, two or more treatments are given together. An example of this is giving patients Abraxane and gemcitabine, which tends to lead to better outcomes than only gemcitabine.

Right now, treatment of advanced pancreatic cancer usually starts with the combination of gemcitabine and Abraxane OR a version of the FOLFIRINOX combination.

These chemotherapy drugs have compounds in them that kill cells. Cancer cells are usually more affected by these drugs than normal cells because cancer cells grow faster. This makes them less stable and more likely to die off when they are in contact with chemotherapy drugs.

There are also new treatments being made that target certain hereditary versions of pancreatic cancer. These versions of pancreatic cancer can be present in up to 15% of patients and are found using genetic testing. An example of one of these treatments is Olaparib. Olaparib was approved by the FDA because it can keep patients that have these forms of pancreatic cancer alive for longer.

Another type of new treatment uses a patient’s immune system to help fight their cancer. This is called biological therapy. An example of this type of treatment is Keytruda.

In general, treatment for advanced pancreatic cancer is made to fit each patient’s needs and type of pancreatic cancer.

Supportive (or palliative) care

Supportive (or palliative) care is usually available to patients with serious health conditions. It helps patients get relief from uncomfortable symptoms like pain. Supportive care can also help you and your family make decisions about your treatment plan that are best for you.

Cancer of the pancreas is one of the faster growing forms of cancer. It can cause uncomfortable symptoms. Supportive care may be even more important for patients with this type of cancer. It also addresses a patient’s emotional and mental health. Having hope and a positive view of life may help patients stay strong during treatment.

Studies have shown that African American patients are less likely to receive palliative care. We want to stress that all patients with pancreatic cancer are eligible to receive this type of care.

Nutrition
High quality nutrition is important during cancer treatment. Your doctor and a registered dietitian can work together to help you support your health through food.

Exercise
Research has shown that exercise is a good way to support your physical and mental health during cancer treatment.

Support groups
Cancer support groups may be a good resource for people who have pancreatic cancer. To find a support group for you, ask your local hospital or cancer center about what groups are available.

Spiritual Support
Spiritual care can be an important part of dealing with cancer treatment. If you have strong ties to a religious institution or organization, it may be worth asking if they offer support groups for cancer.

Clinical Trials
Clinical trials happen all over the world to test new treatment options. These trials test if a new medical treatment is safe and effective through many experiments based on science. In the U.S., this process is overseen by the FDA.

Approving a drug through the FDA takes a long time. Drugs are tested on animals before they are tested on humans to make sure that they are safe.

The choice to participate in a clinical trial is a big one and should not be taken lightly. Clinical trials are experiments. There is a chance that the drug being tested will not work.

However, standard treatments may not help much at certain stages of pancreatic cancer. Some of the new treatments may be better than ones that are used now.

The decision to be part of a clinical trial is not one that you need to make alone. You can ask for advice from your doctor. Important questions to ask are “Is this clinical trial right for me?” and “Is this trial better for me than other treatments?”.

Complementary and Holistic Treatments
We have heard some positive reviews of holistic treatments for managing symptoms related to pancreatic cancer and treatments for it. Holistic treatments can be helpful, but we suggest that these are done along with medical treatment. These should not be used to replace medical treatment.

PANCREATIC CANCER

What are the treatment options?

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