title: Emerging drugs in the treatment of pancreatic cancer.
abstract: BACKGROUND
  Pancreatic cancer is the fourth leading cause of cancer-related death in the US. However, there is a growing belief that novel biological agents could improve survival of patients with this cancer. Gemcitabine-based chemotherapy remains the cornerstone treatment for advanced pancreatic cancers. So far, the current targeted agents that have been used in combination with gemcitabine have failed to improve clinical outcomes. This failure may stem from the heterogeneous molecular pathogenesis of pancreatic cancers, which involves several oncogenic pathways and defined genetic mutations.
  
  
  OBJECTIVE
  The aims of this review are: i) to define the existing treatments available at present for patients with pancreatic cancers in the neo-adjuvant, adjuvant, locally advanced and metastatic settings; ii) to highlight the molecular heterogeneity of the cancers and the rationale for targeting specific oncogenic pathways; iii) to give an overview of targeted agents that may potentially have an impact in the treatment of pancreatic cancers.
  
  
  CONCLUSIONS
  Molecular pathogenesis of pancreatic cancer involves several pathways and defined genetic mutations. Targeting these complex molecular pathways with a combination of novel biological and chemotherapeutic agents could potentially improve patient outcome.
authors.affiliation: Institute of Drug Development, Division of Cancer Research and Therapy Center, University of Texas Health Science Center, San Antonio, Texas 78229, USA. mahalingam@uthscsa.edu
authors.forename: Devalingam
authors.initials: D
authors.lastname: Mahalingam
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Kelly
authors.forename: Ronan T
authors.initials: RT
authors.lastname: Swords
authors.forename: Jennifer
authors.initials: J
authors.lastname: Carew
authors.forename: Steffan T
authors.initials: ST
authors.lastname: Nawrocki
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Giles
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant / Q000639:trends; D016503:Drug Delivery Systems; D015507:Drugs, Investigational / Q000627:therapeutic use*; D006801:Humans; D009154:Mutation; D009857:Oncogenes / Q000502:physiology; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000235:genetics; D015398:Signal Transduction / Q000187:drug effects / Q000502:physiology
chemical_list: D000970:Antineoplastic Agents; D015507:Drugs, Investigational