Pancreatic Cancer Treatment

Palliative treatment of patients with pancreatic cancer is important. Patients should be monitored closely for depression and treated when it arises. Other complications that require palliative intervention include pain; gastric outlet or duodenal obstruction; and bile duct obstruction and subsequent jaundice, cachexia, hypercoagulability and malabsorption caused by exocrine pancreatic insufficiency (Yim et al; 2001). Exocrine pancreatic insufficiency and subsequent malabsorption should be treated with pancreatic enzyme replacement (30,000 IU) of pancrelipase before, during, and after a meal, with increased titration as needed. Weight loss unrelated to malabsorption generally is multifactorial and may be treated with appetite stimulants (e.g., megestrol [Megace], dronabinol [Marinol], corticosteroids) and a high-calorie diet or nutritional supplements (Gunaratnam et al; 2001). Pain from pancreatic cancer can be treated with opioid analgesics, radiation therapy, chemotherapy, or celiac plexus neurolysis (i.e., chemical splanchnicectomy of the celiac plexus with alcohol). Celiac plexus neurolysis eases pain without the side effects of opioids and can be administered intraoperatively, percutaneously, or by endoscopic ultrasonography.
Initiating chemotherapy further increases the risk. For cancer patients initiating chemotherapy, there is currently no approved treatment for the primary prevention of venous thromboembolism risk. Semuloparin significantly decreases the risk of venous thromboembolism by 64% compared to placebo in cancer patients initiating a chemotherapy regimen, according to results of the phase III study "Evaluation of AVE5026 in the Prevention of Venous Thromboembolism in Cancer Patients Undergoing Chemotherapy" (SAVE-ONCO) reported at the 2011 ASCO Annual Meeting (Agnelli et al;