TACP for pancreatic cancer is a specialised catheter-based treatment that delivers chemotherapy through an artery supplying the tumour. This article explains how TACP works, who may be considered, how treatment is given and monitored, possible risks, recovery, treatment response, current evidence, and access to TACP in Germany for international patients. It also explains why TACP does not replace standard systemic treatment.

TACP for Pancreatic Cancer: Regional Chemoperfusion and Patient Care

When pancreatic cancer cannot be removed safely with surgery, treatment focuses on controlling the disease, managing symptoms, and maintaining quality of life. Transarterial chemoperfusion (TACP) is a catheter-based treatment that may be considered for selected patients at specialist centres in Germany. It is used alongside standard treatment rather than as a replacement for it.

TACP Treatment Selection in Pancreatic Cancer

TACP delivers chemotherapy through a catheter positioned in an artery supplying the pancreatic tumour. The aim is to expose the tumour region to a higher local concentration of chemotherapy while limiting, although not eliminating, exposure to the rest of the body. Pancreatic tumours often have a dense fibrotic environment that can limit drug penetration, while drug-efflux mechanisms such as P-glycoprotein may contribute to treatment resistance. Regional arterial delivery is intended to increase chemotherapy exposure within the treated tumour area [2].

How chemoperfusion differs from chemoembolisation and standard chemotherapy.

TACP has mainly been studied in locally recurrent, locally advanced, or previously treated pancreatic cancer. It is not a first-line standard treatment. Suitability depends on the tumour, arterial anatomy, previous treatment, overall health, and treatment goals.

• Previous treatment and current disease status, as TACP does not replace systemic chemotherapy.
• Tumour location and arterial accessibility.
• Recent CT or MRI showing suitable blood vessels for catheter placement.
• Overall health, organ function, blood counts, and blood clotting.
• Assessment by interventional radiology and the oncology team.
• Treatment goals, such as tumour control or symptom relief.

TACP remains a specialised treatment because evidence of a survival benefit is limited and pancreatic arterial anatomy varies between patients. Careful patient selection and experienced catheter placement are therefore important.

TACP Treatment Process in Pancreatic Cancer

A TACP session generally involves angiographic identification of the arterial supply to the tumor, selective catheter placement and regional chemotherapy infusion, followed by post-procedure monitoring.

Mapping the Arteries Supplying the Tumor

Planning starts with recent contrast-enhanced CT or MRI showing the tumour's relationship to the coeliac trunk and superior mesenteric artery. On the day, the interventional radiologist accesses the femoral artery and performs angiography of both vessels to find what feeds the tumour. [3]

The arterial supply varies with the tumour's location. Tumours in the head and neck may receive blood from pancreaticoduodenal branches, while tumours in the body or tail may be supplied by branches of the splenic artery. Angiography helps identify the safest route for treatment [2].

Accurate catheter placement helps direct chemotherapy to the intended tumour area. In the 2024 PAI trial, median overall survival was 12.9 months for head and neck tumours versus 9.0 months for tumours in the body or tail. The study did not establish the reason for this difference [3].

Delivering Regional Chemoperfusion

With the tip confirmed, chemotherapy is infused selectively through the target artery according to the treatment protocol, and the catheter is removed at the end. Infusion times are short: in one trial, gemcitabine 1000 mg/m² was given over 20 minutes, followed by oxaliplatin 100 mg/m² over another 20 minutes, every two weeks. [3]  Protocols vary between centres:

• Drug choice, most often gemcitabine with a platinum agent or mitomycin C, matched to prior treatment.
• Interval between sessions, ranging from every two weeks to roughly every four. It is important to note that reported treatment intervals vary by protocol; the 2024 PAI trial administered treatment every two weeks, whereas older Frankfurt TACP protocols generally used intervals of approximately four weeks.
• Whether chemoperfusion is given alone or combined with systemic chemotherapy and there is no established standard approach defining TACP/PAI as a replacement for systemic treatment in advanced pancreatic cancer.
• Whether one artery or two are perfused, and whether side branches are embolised first to redirect flow.

Early German studies by Vogl and colleagues at University Hospital Frankfurt used gemcitabine and mitomycin C at roughly four-week intervals. These studies helped establish TACP in Germany, but their regimens predate current systemic treatment standards [6].

Monitoring After TACP Treatment

Monitoring takes place after each session and throughout the treatment course:

• Immediately after: the puncture site is watched for bleeding and the patient rests flat for a few hours.
• Before each cycle: blood counts, liver and kidney function are checked to assess treatment tolerance and safety.
• In the 2024 PAI trial, contrast CT or MRI was performed every two cycles to assess tumour response using RECIST 1.1 criteria [3].
• CA 19-9 may also be monitored, although it does not replace imaging or clinical assessment [5].

At each review, the team assesses whether to continue, pause, or stop treatment based on disease response, side effects, and the patient's overall condition.

Local Tumor Control With TACP in Pancreatic Cancer

The main aim of TACP is local tumour control. In some patients, it may also help relieve abdominal or back pain. Available studies suggest potential for local tumour control, but the evidence remains limited. A 2024 phase II trial of pancreatic arterial infusion (PAI) in 51 patients found higher disease control and six-month survival with arterial GEMOX than with intravenous treatment, although median overall survival was not significantly different. A 2024 meta-analysis of 11 studies involving 627 patients found higher odds of partial remission with regional intra-arterial chemotherapy, but the studies used different techniques and drug regimens. These findings therefore cannot be taken as direct evidence for every TACP protocol [1] [3].

Arterial versus intravenous GEMOX in 51 patients; only the six-month survival difference was statistically significant [3].

These results mainly reflect treatment of the pancreatic tumour region. Disease elsewhere in the body is not directly targeted by pancreatic perfusion, so TACP does not provide the same systemic coverage as intravenous chemotherapy. This is why regional treatment, when considered, needs to be assessed as part of the overall treatment strategy rather than as a replacement for systemic therapy.

Recovery and Risks of TACP in Pancreatic Cancer

Recovery post-procedure observation after TACP vary according to the access technique, treatment protocol, centre, and patient's clinical condition; some protocols have been performed on an outpatient basis, whereas others may require observation or short-term admission. Published German studies have reported outpatient treatment, while some patients may require short inpatient observation after the procedure. Perfusion-related effects are usually temporary:

• Abdominal or back pain during infusion was reported in 19.2% of patients in the 2024 PAI trial; in that study, the pain lasted less than 24 hours and did not require analgesia afterward [3].
• Digestive adverse events, including nausea, vomiting, appetite changes and abdominal distension, were reported less frequently with arterial treatment than with intravenous treatment in the 2024 PAI trial (26.9% versus 56.0%) [3].

Fatigue may occur after treatment, although its frequency and duration vary between patients and treatment protocols.

Access-site and vascular effects are uncommon but specific to catheter work:

• Bruising or haematoma at the groin puncture site; alternating between the left and right femoral arteries reduces vessel injury and thrombosis [3].
• Intimal dissection of the iliac artery, reported in small numbers across large intra-arterial series although the frequency varies by access technique, vascular anatomy and procedure and should not be inferred from unrelated intra-arterial treatment series [2].
• Catheter tip displacement, arterial occlusion or local infection, mainly in older studies using implanted ports [2].

In the 2024 PAI trial, grade 3–4 adverse events occurred in 3.8% of patients receiving arterial treatment compared with 24.0% receiving intravenous treatment. However, these findings come from a single study and should not be assumed to apply to every TACP protocol. Individual risk also depends on vascular anatomy, coagulation, kidney function, biliary devices, and centre experience [3].

TACP Results and Evidence in Pancreatic Cancer

The evidence for TACP is still limited, so it is important to look at what studies have shown and where the evidence remains uncertain.

Treatment Response and Symptom Relief

In the 2024 PAI trial, 42.3% of patients receiving arterial treatment had stable disease and 11.5% had a partial response. Stable disease means the cancer has not clearly progressed during assessment. Treatment response is considered alongside imaging, symptoms, and CA 19-9 levels [3].

What Current TACP Evidence Shows

The main published evidence on regional arterial chemotherapy in pancreatic cancer.

Much of the published German TACP evidence comes from early clinical studies rather than large modern randomized trials. The Frankfurt series showed that repeated chemoperfusion could be given as an outpatient procedure with manageable, reversible side effects, [6] while a later phase II study combining intra-arterial mitomycin C and gemcitabine with systemic gemcitabine reported a 25% response rate in 17 patients [2] [6].

The evidence has important limitations. Most studies are small, phase II, or retrospective, and older trials used chemotherapy regimens that predate current standards. Studies also vary in patient groups and treatment protocols. Overall, TACP may provide local tumour control in selected patients, but a survival benefit has not been established [2].

Accessing TACP for Pancreatic Cancer in Germany

For international patients, assessment usually begins with a review of medical records before travel. A German centre needs the full clinical picture to assess whether TACP may be suitable. Patients are usually asked to provide:

• Recent contrast-enhanced CT or MRI of the abdomen, ideally on disc rather than a report alone.
• The histology or cytology report confirming pancreatic adenocarcinoma.
• A treatment summary listing previous chemotherapy, radiotherapy and surgery, with dates.
• Recent bloods: full blood count, liver and kidney function, coagulation and CA 19-9 trend.
• A note on current symptoms, particularly pain, weight change and any biliary stent.

If TACP appears suitable, the interventional radiologist and oncology team review the case and decide how the treatment should be given. This includes choosing the access route, chemotherapy protocol, and timing of TACP alongside any other treatment. TIG GmbH (Treatment in Germany) can help international patients arrange a specialist review of their medical records and coordinate communication with an appropriate centre.

References

1. Cao Y, Yu D, Wu Y, Zhu W. Regional intra-arterial vs. systemic chemotherapy for the treatment of advanced pancreatic cancer: a systematic review and meta-analysis. Frontiers in Oncology. 2024;14:1197424.

2. Laface C, Laforgia M, Molinari P, Foti C, Ambrogio F, Gadaleta CD, Ranieri G. Intra-arterial infusion chemotherapy in advanced pancreatic cancer: a comprehensive review. Cancers. 2022;14(2):450.

3. Huang C, Cheng CS, Shen Y, et al. Digital subtraction angiography-guided pancreatic arterial infusion of GEMOX chemotherapy in advanced pancreatic adenocarcinoma: a phase II, open-label, randomized controlled trial comparing with intravenous chemotherapy. BMC Cancer. 2024;24(1):941.

4. Hatoum H, Rosemurgy A, Bastidas JA, et al. Treatment of locally advanced pancreatic cancer using localized trans-arterial micro perfusion of gemcitabine: combined analysis of RR1 and RR2. The Oncologist. 2024;29(8):690–698.

5. Yang Y, Zong S, Hua Y. Nomogram for prognosis prediction in metastatic pancreatic cancer patients undergoing intra-arterial infusion chemotherapy: incorporating immune-inflammation scores and coagulation indicators. BMC Cancer. 2025;25:107.

6. Vogl TJ, Zangos S, Heller M, Hammerstingl RM, Böcher E, Jacob U, Bauer RW. Transarterial chemoperfusion with gemcitabine and mitomycin C in pancreatic carcinoma: results in locally recurrent tumors and advanced tumor stages. RöFo. 2007;179(11):1181–1188.

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