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Chemotherapy for Pancreatic Neuroendocrine Tumor

Chemotherapy (chemo) uses anti-cancer drugs injected into a vein or taken by mouth to kill cancer cells. These drugs enter the bloodstream and reach almost all areas of the body, making this treatment useful for some types of cancers that have spread. 

Chemo is most often used to treat pancreatic neuroendocrine tumors (NETs) if they:

  • Have not responded to other medicines (such as somatostatin drugs or targeted therapy),
  • Have spread to other organs,
  • Are large or growing quickly,
  • Are causing severe symptoms, or
  • Are high grade (grade 3)

The most commonly used drugs for pancreatic NETs include:

  • Doxorubicin (Adriamycin)
  • Streptozocin
  • Fluorouracil (5-FU)
  • Dacarbazine (DTIC)
  • Temozolomide (Temodar)
  • Capecitabine (Xeloda)
  • Oxaliplatin (Eloxatin)

Some tumors might be treated with more than one drug. Possible combinations include:

  • Doxorubicin plus streptozocin
  • 5-FU plus doxorubicin plus streptozocin
  • Temozolomide plus capecitabine
  • 5-FU plus streptozocin

How is chemotherapy given?

Chemo drugs are typically given into a vein (IV), either as an injection over a few minutes or as an infusion over a longer period of time. This can be done in a doctor’s office, chemotherapy clinic, or in a hospital setting.

Doctors give chemo in cycles, with each period of treatment followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often 2 or 3 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.

The length of treatment for advanced pancreatic NETs is based on how well it is working and what side effects you have.

Possible side effects of chemotherapy

Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemo, which can lead to side effects.

The side effects of chemo depend on the type and dose of drugs given and the length of time they are taken. Common side effects can include:

  • Nausea and vomiting
  • Loss of appetite
  • Hair loss
  • Mouth sores
  • Diarrhea or constipation
  • Increased chance of infections (from having too few white blood cells)
  • Easy bruising or bleeding (from having too few blood platelets)
  • Fatigue (from having too few red blood cells)

Most side effects go away after treatment is finished. Tell your cancer care team about any side effects or changes you notice while getting chemotherapy, so that they can be treated promptly. Often medicines can help prevent or minimize many of the side effects. For example, your doctor can prescribe drugs to help prevent or reduce nausea and vomiting. In some cases, the doses of the chemo drugs might need to be lowered or treatment might need to be delayed or stopped to keep the effects from getting worse.

More information about chemotherapy

For more general information about how chemotherapy is used to treat cancer, see Chemotherapy.

To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Chan JA, Kulke M, Clancy TE. Metastatic well-differentiated pancreatic neuroendocrine tumors: Systemic therapy options to control tumor growth and symptoms of hormone hypersecretion. UpToDate website. Updated August 31, 2018. Accessed October 9, 2018.

National Cancer Institute. Physician Data Query (PDQ). Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment – Patient Version. 2018. Accessed at on October 5, 2018.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Neuroendocrine and Adrenal Tumors. V.3.2018. Accessed at on October 2, 2018.

Pasricha G, Padhi P, Daboul N, Monga DK. Management of Well-differentiated Gastroenteropancreatic Neuroendocrine Tumors (GEPNETs): A Review. Clin Ther. 2017 Nov;39(11):2146-2157. doi: 10.1016/j.clinthera.2017.10.010.

Schneider DF, Mazeh H, Lubner SJ, Jaume JC, Chen H. Chapter 71: Cancer of the endocrine system. In: Niederhuber JE, Armitage JO, Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa. Elsevier: 2014.

Singhi AD, Klimstra DS. Well-differentiated pancreatic neuroendocrine tumours (PanNETs) and poorly differentiated pancreatic neuroendocrine carcinomas (PanNECs): concepts, issues and a practical diagnostic approach to high-grade (G3) cases. Histopathology. 2018 Jan;72(1):168-177. doi: 10.1111/his.13408.

Last Revised: October 30, 2018

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