Gut Liver.  2016 May;10(3):340-347. 10.5009/gnl15465.

Systemic Chemotherapy in Advanced Pancreatic Cancer

  • 1Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.


Pancreatic cancer remains one of the most lethal cancers. These patients often have multiple symptoms, and integrated supportive care is critical in helping them remain well for as long as possible. Fluorouracil-based chemotherapy is known to improve overall survival (OS) by approximately 3 months, compared to the best supportive care alone. A 1997 study comparing gemcitabine and fluorouracil treatment of advanced pancreatic cancer patients showed an improvement in OS of 1 month in patients receiving gemcitabine. Over the next 10 years, multiple randomized studies compared single-agent gemcitabine with combination chemotherapy and showed no effective survival improvement. However, the addition of erlotinib, an epidermal growth factor receptor (EGFR) inhibitor, was associated with a significant improvement in OS of approximately 2 weeks. However, adoption of this regimen has not been widespread because of its limited effect and added toxicity. Two clinical trials have recently prolonged OS in advanced pancreatic cancer patients by almost 1 year. The first compared FOLFIRINOX with gemcitabine alone, and was associated with a significant improvement in median survival. The second compared gemcitabine and nab-paclitaxel with gemcitabine alone, and was associated with improvements in OS. At present, these regimens are considered standard treatment for patients with good performance statuses.


Pancreatic neoplasms; Drug therapy; Gemcitabine; Fluorouracil

MeSH Terms

Antineoplastic Agents/*therapeutic use
Antineoplastic Combined Chemotherapy Protocols/therapeutic use
Deoxycytidine/administration & dosage/analogs & derivatives
Fluorouracil/administration & dosage
Molecular Targeted Therapy/methods
Pancreatic Neoplasms/*drug therapy
Randomized Controlled Trials as Topic
Treatment Outcome
Antineoplastic Agents
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