Metastatic pancreatic adenocarcinoma: current standards, future directions

Pancreatic cancer is the fourth most common cause of cancer death in the United States. In the landmark study in 1997, which established the central although modest role of gemcitabine in this disease, progress has been incremental. Significant developments have been an increased acceptance for combination chemotherapy in patients with good performance status in addition to an increased understanding of tumorigenesis. The parallel technologic and engineering developments that have occurred hold the promise of exploiting this understanding. This review attempts to summarize the standard therapeutic approach to metastatic pancreatic cancer and point to areas that hold promise for the future.