[Pancreatic cancer: ten years of systemic therapy]

By today, systemic therapy for pancreatic cancer remains a huge challenge considering the last 10 years existing data. In 1997, gemcitabine emerged as a new reference treatment in advanced disease stage displaying a valuable clinical benefit rate but an overall survival limited to 6 months. In 2007, around 20 large phase III trials enrolling 7000 patients have evaluated a lot of new cytotoxic and biological compounds, but only a modest and poorly clinically relevant benefit in survival of 0.5 month was obtained, a result in sharp contrast to what it is observed in other types of cancer, where some substantial progress was noted over the last ten years. Considering the aggressive and multiresistant phenotype of this cancer, a different and more selective approach for development of new therapies has to be envisaged, starting with the deciphering of the biomolecular mechanism, first step towards the discovery of new therapeutic targets. By this way only, we could anticipate relevant advances and better exploitation and exploration of future targeted therapies.