Chemotherapy in pancreatic adenocarcinoma.

Pancreatic cancer is a malig - nancy with a very poor prognosis, even when radically resected. In advanced disease chemotherapy has a role in terms of clinical benefit and symptoms palliation, more than sur - vival advantage. Gemcitabine as a single agent is the first-line standard treatment since 1997. Several trials failed to demonstrate a survival advantage of chemotherapy doublets or gemc - itabine combined with biological agents versus gemcitabine alone in phase III trials. Erlotinib was the only agent to produce a statistically significant improvement of survival when com - bined with gemcitabine versus gemcitabine alone. Nevertheless, the clinical application of these literature data remains controversial. However, a meta-analysis showed that combina - tion chemotherapy is superior to gemcitabine alone in terms of survival and clinical benefit in selected subgroups of patients. In unresectable locally advanced disease chemotherapy is ac - tive, whereas no high level evidence exists about a possible superiority of chemoradiation. Chemotherapy followed by chemoradiation rep - resents a promising treatment schedule, result - ing better than chemotherapy alone in a retro - spective analysis. Adjuvant chemotherapy is nowadays a stan - dard treatment, with both 5-FU and gemc - itabine resulted superior to observation. In - stead adjuvant chemoradiation is not a stan - dard, even though it can be suggested in se - lected subgroups of patients. In resectable lo - cally advanced disease neoadjuvant therapy is still investigational. Chemoradiation or chemotherapy followed by chemoradiation pro - duced promising results in phase II trials. Pos - sible future gain in terms of survival could come from better neoadjuvant treatments in potentially resectable pancreatic carcinoma. Therefore, this setting should stimulate studies with new drugs and combinations and poten - tial biological predictive factors.