Pancreatic Cancer Medications: Types and How They Work

What is Pancreatic Cancer?

The pancreas is a gland that is located behind the stomach that plays a vital role in digestion and blood sugar regulation. In the majority of pancreatic cancer cases, it starts to begin in the exocrine cells of the pancreas, which helps with digestion, and the most common type of cancer is known as pancreatic ductal carcinoma.

These cancers and their location, along with subtle early symptoms, are often diagnosed at an advanced stage, making systemic treatments and medical care crucial for a positive treatment outcome and recovery.

Types of medications for Pancreatic Cancer

Pancreatic cancer treatment often involves a multimodal treatment approach, but medications, especially like chemotherapy and targeted drugs, might play a vital role in the best treatment outcome and long-term survival.

Chemotherapy

How it works:

Chemotherapy often uses powerful drugs that used to destroy fast-growing cancer cells throughout the body. It can be used standalone or in combination with other cancer treatments. 

Common chemotherapy drugs 

• Gemcitabine (Gemzar): These are one of the most commonly used drugs in the treatment of this cancer. It helps to slow and stops the cancer growth in patients. 
• 5-Fluroroucil (5-FU): These are some of the drugs often used in combination of treatments and it blocks the synthesis of DNA in cancer cells.
• FOLFIRINOX: This is a combination of four drugs including Folinic acid (leucovorin), Flurourocil (5-FU), IRinotecan, Oxaliplatin. These drug combinations are more aggressive but can be more effective in younger, more healthy, fit patients.
• Nab-paclitaxel (Abraxane): These drugs are often used with gemcitabine, and it helps in cancer cell division in the cancer patients.

What’s expected during the procedure

There are some side effects that might include fatigue, nausea, low blood cell counts and hair loss, but some supportive medications can help to manage them. 

Targeted therapy

How it works:

Targeted therapies are effective cancer drugs designed to interfere with some specific molecules or pathways that cancer cells need to grow. These treatments are aimed to harm only cancer cells and avoid healthy cells.

Example:

• Erlotinib (Tarceva): These drugs are the EGFR (Epidermal growth factor receptor), which is more often overactive in these types of cancer cells.
• Olaparib (Lynparza): This is a PARP inhibitor generally used in patients with BRCA1 or BRCA2 gene mutations. These drugs blocked the repair of cancer cell DNA, which caused them to die.

What’s to expect:

There are some of the drugs that cause side effects that depend on the drug, including skin rash, diarrhea, fatigue, or appetite changes. These side effects are often milder than side effects of chemotherapy. 

Immunotherapy

How it works:

Immunotherapy helps to stimulate the body’s immune system to fight against cancers. These are not yet widely effective for most of these types of cancers. Currently much research is underway to find out whether cancer patients benefit, especially those with specific genetic traits. 

Key immunotherapy drugs are in use or under investigation.

Immune checkpoint inhibitors

There are some drugs like pembrolizumab (Keytruda) that might be used in rare cases where the tumor has microsatellite instability- high (MSI-H) or mismatch repair deficiency (dMMR). 

What’s to expect:

Immunotherapy drugs can cause inflammation-related side effects in skin, lungs and liver. But these are better tolerated than chemotherapy for eligible cancer patients.

Supportive medications

Pancreatic cancer and its treatments can cause side effects, such as fatigue, weight loss, pain, nausea that require supportive medications for the disease management.

These may include:

• Pain relief medications: (opioids)
• Enzyme replacement therapy: These drugs help to digest food if the pancreas is not working properly. 
• Antiemetics: These drugs are given to control nausea in patients
• Steroids: These drugs are used to reduce inflammation, which also helps to boost appetite. 
• Blood thinners: These drugs are used to prevent blood clots, which are more common in these cancer patients. 

Clinical drugs

These cancers are highly challenging to treat and manage. In most cases, patients are often encouraged to consider clinical trials.

These may include:

• New chemotherapy combinations
• Experimental targeted therapies
• Novel immunotherapies
• m-RNA based treatments
• Personalised medicine approaches are based on genetic profiling

Consult with your oncologist if there are any trials that can match your cancer. These clinical trials offer access to advanced cancer treatments not yet widely available to cancer patients.

Personalised Medicine and Genetic Testing

Currently many treatment plans start with genetic testing or molecular testing of the tumor. This will help a healthcare provider.

These may include:

• Identify actionable mutations such as BRCA1/2, KRAs, or others.
• Match with patients that are suitable targeted therapies
• Determine whether immunotherapy might work or not

This personalized treatment approach starts to increase the chances of treatment success and helps to reduce any unnecessary side effects.