Systemic therapy for pancreatic cancer.

Pancreatic adenocarcinoma is typically diagnosed at an advanced stage, at which point systemic therapy becomes the primary modality of treatment. Although gemcitabine monotherapy has remained the standard of care for the past decade, a number of large studies conducted over the past several years have suggested that some advantages may be derived from the use of combination therapy, such as the addition of a platinum agent to gemcitabine. The application of pharmacokinetic principles to drug delivery may confer additional benefit as well. Furthermore, with an increasing understanding of the cellular and stromal events that govern pancreatic tumor maintenance, molecularly targeted agents are under active investigation and may prove to serve a critical role in our therapeutic armamentarium. The combination of standard cytotoxic agents and these newer targeted compounds offers promise that we will be able to make significant inroads in improving clinical outcomes for patients with advanced pancreatic cancer.