Treatment of advanced and metastatic pancreatic cancer.

The majority of adenocarcinoma of the pancreas are non-resectable at diagnosis due to locally advanced or metastatic disease. There will be an estimated 28,900 new cases of pancreatic cancer diagnosed in the United States in 1998. In data collected from 1986-1993, the five year survival of all stages combined was 4%. Realizing that most patients present with advanced disease, and there are no acceptable screening methods to detect early stage disease, efforts to develop active anti-cancer agents with minimal toxicity are essential in order to improve the quality of life and survival. Several 5-fluorouracil based regimens have been tried without a significant impact on palliation or survival. Recently, the anti-metabolite gemcitabine has been approved for use in individuals with locally advanced and metastatic disease, primarily on the basis of improved functional status. Many cytotoxic agents have proven ineffective in the treatment of this disease. There are several ongoing studies investigating the role of new cytotoxic and biologic agents.