Chemotherapeutic gemcitabine doublets in pancreatic carcinoma

Single-agent gemcitabine remains the standard treatment for advanced pancreas cancer. Results of four phase III trials reported in 2004 indicated no survival benefit for single-agent exatecan or combinations of exatecan, pemetrexed, and oxaliplatin with gemcitabine compared with gemcitabine alone. It is unclear whether a trend toward improved outcome with the gemcitabine/oxaliplatin combination was attributable to use of a fixed-dose rate infusion regimen of gemcitabine in the combination arm, a method of administration that appears to be associated with benefits compared with standard gemcitabine infusion. Novel approaches to treatment currently under investigation include refining schedules of administration of combination therapy, combining gemcitabine with molecular targeted therapy, and combining gemcitabine with low-molecular-weight heparin.