title: Systemic therapy for advanced pancreatic cancer: individualising cytotoxic therapy.
abstract: BACKGROUND
  Pancreatic cancer is an aggressive solid tumour associated with a high risk of local invasion and metastatic spread. In the absence of validated screening approaches, many patients present with advanced, incurable disease. Despite advances in treatment, the prognosis for patients with advanced pancreatic cancer remains poor. The benefits of surgical resection and radiation are unproven in this setting and, as patients generally present with distant metastases, systemic therapy forms the mainstay of treatment. The importance of selecting the optimal cytotoxic therapy remains to be critical to improving outcome and retaining quality of life. This review sets out to compare the current therapies available for advanced pancreatic cancer.
  
  
  METHODS
  This review examines the evolution of the systemic management of advanced pancreatic cancer, with a particular focus on the landmark Phase III trials identified from an extensive PubMed and Google scholar literature search. The article summarises the cytotoxic agents in use and the results of two decades of clinical trials to culminate in an almost doubling of survival in clinical trials.
  
  
  CONCLUSIONS
  In the concluding expert opinion, the challenges interpreting and translating trial results into clinical practice are discussed, where patients are often older and of worse performance status. In the future, novel biomarkers might be used to tailor therapy.
authors.affiliation: RCSI Hospitals Group (Beaumont Hospital), Cancer Clinical trials and Research Unit , Dublin 9 , Ireland dearbhailecollins@beaumont.ie.
authors.forename: Dearbhaile Catherine
authors.initials: DC
authors.lastname: Collins
authors.forename: Patrick Glyn
authors.initials: PG
authors.lastname: Morris
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017326:Clinical Trials, Phase III as Topic; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D066246:ErbB Receptors / Q000235:genetics / Q000378:metabolism; D006801:Humans; D009154:Mutation; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D040262:Receptors, Vascular Endothelial Growth Factor / Q000378:metabolism; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; C512478:EGFR protein, human; D066246:ErbB Receptors; D040262:Receptors, Vascular Endothelial Growth Factor; D000093542:Gemcitabine
keywords: 5-fluorouracil; FOLFIRINOX; combination chemotherapy; erlotinib; gemcitabine; irinotecan; metastatic pancreatic cancer; nab-paclitaxel; oxaliplatin