title: Metastatic pancreatic cancer: old drugs, new paradigms.
abstract: OBJECTIVE
  Metastatic pancreatic ductal adenocarcinoma has a grim prognosis and gemcitabine has been the reference treatment for 15 years. In this article, we will review current first-line treatments for metastatic pancreatic adenocarcinoma focusing on randomized studies.
  
  
  RESULTS
  Among the numerous randomized phase III studies comparing gemcitabine as single agent to gemcitabine combined to a new agent, only the gemcitabine-erlotinib combination has shown a small, but statistical improvement in survival. A trend to better survival was also observed with a gemcitabine-capecitabine regimen. The use of low-weight heparin may be of value to reduce venous thromboembolic events. In selected patients with good performance status ECOG 0-1, the Folfirinox regimen, when compared with gemcitabine, was associated with more toxicities and significantly increased median survival from 6.8 to 11.1 months.
  
  
  CONCLUSIONS
  Gemcitabine (with or without erlotinib or capecitabine) is still the reference treatment in patients with ECOG performance status 2. Folfirinox is a new more toxic and more efficient regimen that may be considered in patients with good performance status.
authors.affiliation: Department of Medical Oncology, Centre Alexis Vautrin, Nancy University, Vandoeuvre-lès-Nancy, France. t.conroy@nancy.fnclcc.fr
authors.forename: Thierry
authors.initials: T
authors.lastname: Conroy
authors.forename: Céline
authors.initials: C
authors.lastname: Gavoille
authors.forename: Antoine
authors.initials: A
authors.lastname: Adenis
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy*; D000971:Antineoplastic Combined Chemotherapy Protocols; D000069287:Capecitabine; D021441:Carcinoma, Pancreatic Ductal / Q000188:drug therapy* / Q000473:pathology; D017326:Clinical Trials, Phase III as Topic; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D000069347:Erlotinib Hydrochloride; D005472:Fluorouracil / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D009362:Neoplasm Metastasis; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D000077150:Oxaliplatin; D017239:Paclitaxel / Q000008:administration & dosage / Q000627:therapeutic use; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D010984:Platinum / Q000008:administration & dosage / Q000627:therapeutic use; D011799:Quinazolines / Q000008:administration & dosage / Q000627:therapeutic use; D000093542:Gemcitabine
chemical_list: D009944:Organoplatinum Compounds; D011799:Quinazolines; D000077150:Oxaliplatin; D003841:Deoxycytidine; D010984:Platinum; D000069287:Capecitabine; D006493:Heparin; D000069347:Erlotinib Hydrochloride; D017239:Paclitaxel; D005472:Fluorouracil; D000093542:Gemcitabine