Gastrointestinal tract: Edited by Alain HendliszMetastatic pancreatic cancer: old drugs, new paradigmsConroy, Thierrya; Gavoille, Célinea; Adenis, Antoineb Author Information aCentre Alexis Vautrin, Nancy University, Nancy, France bCentre Oscar Lambret, Catholic University, Lille, France Correspondence to Professor Thierry Conroy, MD, Department of Medical Oncology, Centre Alexis Vautrin, 54511 Vandoeuvre-lès-Nancy, France Tel: +33 3 83 59 84 60; e-mail: [email protected] Current Opinion in Oncology: July 2011 - Volume 23 - Issue 4 - p 390-395 doi: 10.1097/CCO.0b013e3283473610 Buy Metrics Abstract Purpose of review 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. Recent findings 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. Summary 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. © 2011 Lippincott Williams & Wilkins, Inc.