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Drug therapy of pancreatic cancer

Adjuvant treatment

The purpose of adjuvant treatment is to prevent or prolong time to recurrence after pancreatectomy for pancreatic cancer. Patients who are operated radically for pancreatic cancer, and where there is no sign of disseminated cancer, may be candidates for adjuvant treatment.

The treatment consists of 6 months of Nordic FLv which is administered every other week for 13 treatments.

The patient should be under 75 years and have a general health status equivalent to ECOG 0–1 or Karnofsky 70 or better. Nordic FLv is generally a mildly toxic regimen, but the toxicity must be continually assessed during the treatment period since, based on experience, these patients do not tolerate chemotherapy well.

Tumor-directed palliation

5-FU has been the reference treatment in randomized studies for andvanced pancreatic cancer. From the end of the 1990's, gemcitabine has been the first-line choice for advanced cancer is some countries including the USA and Germany.

In Norway, gemcitabine is recommended to certain patients with non-resectable pancreatic cancer. 

  • The dose is 1000 mg/m2 body surface and is given once a week by intravenous infusion. 

  • The first cycle consists of 7 weeks of treatment followed by a 1 week break.

  • Thereafter, 4-week cycles are administered with 3 treatment weeks and a 1 week break.

The dose is adjusted according to the degree of bone marrow suppression, as well as creatinine and liver tests.

The side effect is primarily vomiting lasting for a few days after the infusion. This can be relieved by serotonin-receptor antagonists and glucocorticosteroids. A small portion of these patients lose their hair after long-term treatment and some have temporary influenza-like symptoms. If the patient is clinically stable, a CT scan should be done every 3 months for objective assessment of the tumor effect. For tumor progression or worsened general health condition, chemotherapy should be stopped, which should be discussed with the patient before starting treatment. For a stable tumor disease, the treatment should continue until the disease symptoms are suppressed.

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