Metastatic pancreatic cancer.

Metastatic pancreatic cancer is one of the leading causes of cancer-related deaths in North America and Europe. In the past, patients with metastatic pancreatic cancer have had few treatment options. However, recently, several effective palliative therapies and procedures have become available. The systemic administration of gemcitabine has been shown to result in clinical benefit and in a prolongation of median survival, and is now established as the standard first-line treatment for patients with metastatic pancreatic cancer. Clinical trials are exploring whether the use of gemcitabine-based chemotherapy combinations will result in further benefit. Several novel chemotherapeutic and biologic agents appear promising, and are likely to play a role in the treatment of patients with pancreatic cancer in the future. Palliative procedures, such as biliary or duodenal stenting and celiac plexus blockade, should be considered in conjunction with systemic therapy in patients with specific complications from pancreatic cancer.