New directions in systemic therapy of pancreatic cancer.

BACKGROUND The aggressiveness of pancreatic adenocarcinoma makes it a deadly disease, with its incidence rate and fatality rate almost equal. Surgery represents the only means to provide cure to patients with pancreatic cancer, though the 5-year survival is less than 10%. METHODS We review the data on surgical and systemic therapies and provide more details on a newer biologically based medical approach. RESULTS Neoadjuvant chemotherapy protocols are confined to one or two institutions, and adjuvant chemotherapy and chemoradiation therapy protocols are far from being standardized. Chemoradiation therapy for locally advanced pancreatic cancer offers limited benefits. Protocols that include gemcitabine and 5-fluorouracil, while comparing favorably to historical controls, offer median survivals at approximately 8 months. CONCLUSIONS More effective protocols with combinations of approaches agents are needed to improve the treatment of pancreatic cancer.