Current status in chemotherapy for advanced pancreatic adenocarcinoma.

Pancreatic ductal adenocarcinoma (PDA) is one of the most lethal types of cancer in the United States. Surgical resection remains the only curative treatment, but fewer than 20% of patients qualify as candidates. The past two decades saw major changes in the treatment of advanced PDA, a shift of standard protocol from 5-fluorouracil to gemcitabine and gemcitabine-based combinations, the introduction of molecular target therapy and multi-agent regimens. However, even with advancements in medicine, PDA is still extremely resistant to currently available regimens, which results in poor prognosis, with only 5.2% of patients alive at three years. This provides a challenge to scientists as they seek to find the best active regimen with the least side-effects. In this article, we review the current recommended guidelines from the National Comprehensive Cancer Network. In addition, we highlight major clinical trials since 2011. Pancreatic ductal adenocarcinoma is the fourth leading cause of cancer-related death in men and women in the US and the eighth leading cause of cancer death in men and ninth in women worldwide (1, 2). In the US, approximately 43,920 patients are diagnosed with pancreatic cancer involving the exocrine function, with the majority being adenocarcinoma arising from the ductal epithelium (3). Despite dismal survival rates, the incidence of pancreatic cancer and mortality rates in the U.S. have remained the same over the past two decades (4, 5). The peak incidence occurs during the seventh and eight decade of life and is rare before the age of 45 years (2). The incidence is greater in males than females and in blacks than whites (6). Although the overall prognosis of pancreatic cancer is poor (median survival=3.5 months, with 5.2% alive at three years), novel approaches have been explored to increase survival rates. In this article, we review the current standard chemotherapy treatment and highlight important studies since 2011, with specific emphasis on locally advanced and metastatic disease. Current Treatment