A comprehensive update on the use of chemotherapy for metastatic pancreatic adenocarcinoma

Gemcitabine (Gemzar, Lilly), received FDA approval in 1996 for first line treatment of locally advanced (nonresectable stage II or III) or metastatic (stage IV) pancreatic cancer and as second-line treatment for pancreatic cancer previously treated with 5-fluorouracil. Gemcitabine use has produced important clinical benefit responses and modest survival benefits. For the first time, quality of life and survival benefits are being consistently reported for significant percentages of treated patients. The activity of gemcitabine and its favorable toxicity profile has prompted a generation of phase II and III trials exploring the efficacy of gemcitabine based combine based combination chemotherapy regimes. Two, three, and four drug gemcitabine-based combinations are often reporting response rates greater than 20% and median survivals of 8 or more months. This review will summarize recently reported phase II and III trials and highlight planned or ongoing trials of encouraging new drugs or drug combinations.