Clinical update of gemcitabine in pancreas cancer.

Pancreatic cancer constitutes less than 2% of all cancers diagnosed in Singapore, consistent with the proportion described worldwide. About 40% of patients are diagnosed when the disease is locally advanced but without metastases. Another 40% are diagnosed with distant metastases. Only 20% are diagnosed when resectable. Most are adenocarcinomas arising from the head of the pancreas. Systemic chemotherapy is used for advanced metastatic pancreatic cancer but has met with limited success. Gemcitabine is a new fluorine-substituted cytarabine compound. In a randomised study it appears to confer statistically significant, although modest, improvement in quality of life and survival of patients with metastatic pancreas cancer. Evaluation of the drug in combination chemotherapy regimens and with radiation continues.