Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Advanced pancreatic carcinoma: current treatment and future challenges

Abstract

Pancreatic adenocarcinoma is the most lethal of the solid tumors and the fourth leading cause of cancer-related death in North America. Most patients present with locally advanced or metastatic disease that precludes curative resection. These patients have an extremely poor prognosis. In the absence of effective screening methods, considerable efforts have been made during the past decade to identify better systemic treatments. Unfortunately most trials have not shown a survival advantage for most therapies. In tandem with this increased clinical research, there has also been an expansion of preclinical laboratory investigation. These preclinical studies revealed many of the molecular mechanisms involved in pancreatic cancer development, which has provided insights into why current therapies are ineffective. These new discoveries provide some optimism that new agents inhibiting specific targets will improve outcome and overcome the resistance of pancreatic cancer to most standard treatments. We review the current standards of care for patients with locally advanced and metastatic pancreatic carcinoma and outline some future directions for the development of new treatment strategies.

Key Points

  • Pancreatic adenocarcinoma has a high propensity for locoregional invasion and early development of distant metastases

  • Approximately 80% of patients present with locally advanced or metastatic disease that precludes curative surgery, and long term survival is poor

  • In 1997 gemcitabine was established as the standard first-line treatment for patients with advanced disease based on clinical benefit and survival improvement compared with 5-fluorouracil-based chemotherapy

  • During the past decade several clinical trials assessing different cytotoxic agents and combination chemotherapy failed to improve treatment outcomes

  • The combination of a targeted agent, erlotinib, with gemcitabine resulted in a small but significant improvement in survival compared with gemcitabine alone

  • A better understanding of the biology and molecular changes that occur in pancreatic cancer will permit the development of new agents to overcome resistance

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Jemal, A. et al. Cancer statistics. CA Cancer J. Clin. 58, 71–96 (2008).

    Article  Google Scholar 

  2. Canadian Cancer Society/National Cancer Institute of Canada: Canadian Cancer Statistics 2008, Toronto, Canada, 2008. April 2008, ISSN 0835–2976.

  3. Cubilla, A. L. & Fitzgerald, P. J. Tumors of the exocrine pancreas. in Atlas of Tumor Pathology (Eds Hartmann, W. H. & Sobin, H.), 2nd series, fascicle 19 (Armed Forces Institute of Pathology, Washington, 1984).

    Google Scholar 

  4. Solcia, E., Capella, C. & Kloppel, G. Tumors of the exocrine pancreas. in Tumors of the Pancreas (Eds Rosai, J. & Sobin, L. H.) 145 (Armed Forces Institute of Pathology, Washington, 1997).

    Google Scholar 

  5. Chu, G. C., Kimmelman, A. C., Hezel, A. F. & DePinho, R. A. Stromal biology of pancreatic cancer. J. Cell. Biochem. 101, 887–907 (2007).

    Article  CAS  Google Scholar 

  6. Mahadevan, D. & Von Hoff, D. D. Tumor–stroma interactions in pancreatic ductal adenocarcinoma. Mol. Cancer Ther. 6, 1186–1197 (2007).

    Article  CAS  Google Scholar 

  7. Winter, J. M. et al. 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J. Gastrointest. Surg. 10, 1199–1211 (2006).

    Article  Google Scholar 

  8. Sohn, T. A. et al. Resected adenocarcinoma of the pancreas—616 patients: results, outcomes, and prognostic indicators. J. Gastrointest. Surg. 4, 567–579 (2000).

    Article  CAS  Google Scholar 

  9. Yeo, C. J. et al. Pancreaticoduodenectomy for cancer of the head of the pancreas: 201 patients. Ann. Surg. 221, 721–731 (1995).

    Article  CAS  Google Scholar 

  10. Wong, H. H. & Lemoine, N. R. Pancreatic cancer: molecular pathogenesis and new therapeutic targets. Nat. Rev. Gastroenterol. Hepatol. 6, 412–422 (2009).

    Article  CAS  Google Scholar 

  11. Royal, R. E., Wolff, R. A. & Crane, C. H. in Cancer Principles and Practice of Oncology (Eds De Vita Jr, V. T., Lawrence, T. & Rosenberg, S. A.) 8th edition, 1, 1118–1120 (Lippincott Williams and Wilkins, Philadelphia, USA, 2008).

    Google Scholar 

  12. Khorana, A. A. & Fine, R. L. Pancreatic cancer and thromboembolic disease. Lancet Oncol. 5, 655–663 (2004).

    Article  CAS  Google Scholar 

  13. Sohail, M. A. & Saif, M. W. Role of anticoagulation in the management of pancreatic cancer. JOP 10, 82–87 (2009).

    PubMed  Google Scholar 

  14. Icli, F. et al. Low molecular weight heparin (LMWH) increases the efficacy of cisplatinum plus gemcitabine combination in advanced pancreatic cancer. J. Surg. Oncol. 95, 507–512 (2007).

    Article  CAS  Google Scholar 

  15. von Delius, S. et al. Effect of low-molecular weight heparin on survival in patients with advanced pancreatic adenocarcinoma. Thromb. Haemost. 98, 434–439 (2007).

    Article  CAS  Google Scholar 

  16. Riess, H. et al. Rational and design of PROSPECT-CONKO 004: a prospective, randomized trial of simultaneous pancreatic cancer treatment with enoxaparin and chemotherapy [abstract]. BMC Cancer 8, a361 (2008).

    Article  Google Scholar 

  17. Heinemann, V. & Boeck, S. Perioperative management of pancreatic cancer. Ann. Oncol. 19 (Suppl. 7), vii273–vii278 (2008).

    PubMed  Google Scholar 

  18. Kalser, M. H. & Ellenberg, S. S. Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch. Surg. 120, 899–903 (1985).

    Article  CAS  Google Scholar 

  19. Klinkenbijl, J. H. et al. Adjuvant radiotherapy and 5-fluorouracil after resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer group. Ann. Surg. 230, 776–784 (1999).

    Article  CAS  Google Scholar 

  20. Neoptolemos, J. P. et al. European Study Group for Pancreatic Cancer. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N. Engl. J. Med. 350, 1200–1210 (2004).

    Article  CAS  Google Scholar 

  21. Crane, C. H., Ben-Losef, E. & Small, W. Jr. Chemotherapy for pancreatic cancer. N. Engl. J. Med. 350, 2713–2715 (2004).

    Article  CAS  Google Scholar 

  22. Oettle, H. et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer. JAMA 297, 267–277 (2007).

    Article  CAS  Google Scholar 

  23. Neuhaus, P. et al. CONKO-001: final results of the randomized, prospective, multicentre phase III trial of adjuvant chemotherapy with gemcitabine versus observation in patients with resected pancreatic cancer [abstract]. J. Clin. Oncol. 26 (Suppl. 18), a4504 (2008).

    Article  Google Scholar 

  24. Regine, W. F. et al. Fluorouracil vs gemcitabine chemotherapy before and after fluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma. JAMA 299, 1019–1026 (2008).

    Article  CAS  Google Scholar 

  25. Neoptolemos, J. et al. ESPAC-3(v2): A multicenter, international, open-label, randomized, controlled phase III trial of adjuvant 5-fluorouracil/folinic acid (5-FU/FA) versus gemcitabine (GEM) in patients with resected pancreatic ductal adenocarcinoma [abstract]. J. Clin. Oncol. 27 (Suppl. 18), a4505 (2009).

    Article  Google Scholar 

  26. Wolff, R. A., Varadhachary, G. R. & Evans, D. B. Adjuvant therapy for adenocarcinoma of the pancreas: Analysis of reported trials and recommendations for future progress. Ann. Surg. Oncol. 15, 2773–2786 (2008).

    Article  Google Scholar 

  27. Burris III, H. A. et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J. Clin. Oncol. 15, 2403–2413 (1997).

    Article  Google Scholar 

  28. Heinemann, V. et al. Randomized phase III trial of gemcitabine plus cisplatin compared with gemcitabine alone in advanced pancreatic cancer. J. Clin. Oncol. 24, 3946–3952 (2006).

    Article  CAS  Google Scholar 

  29. Colucci, G. et al. Gemcitabine alone or with cisplatin for the treatment of patients with locally advanced and/or metastatic pancreatic carcinoma: A prospective, randomized phase III study of the Gruppo Oncologico dell'Italia Meridionale. Cancer 94, 902–910 (2002).

    Article  CAS  Google Scholar 

  30. Louvet, C. et al. Gemcitabine in combination with oxaliplatin compared with gemcitabine alone in locally advanced or metastatic pancreatic cancer: Results of a GERCOR and GISCAD phase III trial. J. Clin. Oncol. 23, 3509–3516 (2005).

    Article  CAS  Google Scholar 

  31. Poplin, E. et al. Phase III, randomized study of gemcitabine and oxaliplatin versus gemcitabine (fixed-dose rate infusion) compared with gemcitabine (30-minute infusion) in patients with pancreatic carcinoma E6201: a trial of the Eastern Cooperative Oncology Group. J. Clin. Oncol. 27, 3778–3785 (2009).

    Article  CAS  Google Scholar 

  32. Berlin, J. D. et al. Phase III study of gemcitabine in combination with fluorouracil versus gemcitabine alone in patients with advanced pancreatic carcinoma: Eastern cooperative oncology group trial E2297. J. Clin. Oncol. 20, 3270–3275 (2002).

    Article  CAS  Google Scholar 

  33. Riess, H. et al. A randomised, prospective, multicenter, phase III trial of gemcitabine, 5-fluorouracil (5-FU), folinic acid vs gemcitabine alone in patients with advanced pancreatic cancer [abstract]. J. Clin. Oncol. 23 (Suppl. 16), a4009 (2005).

    Article  Google Scholar 

  34. Herrmann, R. et al. Gemcitabine plus capecitabine compared with gemcitabine alone in advanced pancreatic cancer: a randomized, multicenter, phase III trial of the Swiss Group for Clinical Cancer Research and the Central European Cooperative Oncology Group. J. Clin. Oncol. 25, 2212–2217 (2007).

    Article  CAS  Google Scholar 

  35. Cunningham, D. et al. Phase III randomized comparison of gemcitabine (GEM) versus gemcitabine plus capecitabine (GEM-CAP) in patients with advanced pancreatic cancer [abstract]. Eur. J. Cancer 3 (Suppl. 3), a12 (2005).

    Google Scholar 

  36. Rocha Lima, C. M. et al. Irinotecan plus gemcitabine results in no survival advantage compared with gemcitabine monotherapy in patients with locally advanced or metastatic pancreatic cancer despite increased tumor response rate. J. Clin. Oncol. 22, 3776–3783 (2004).

    Article  CAS  Google Scholar 

  37. Stathopoulos, G. P. et al. A multicenter phase III trial comparing irinotecan-gemcitabine (IG) with gemcitabine (G) monotherapy as first-line treatment in patients with locally advanced or metastatic pancreatic cancer. Br. J. Cancer 95, 587–592 (2006).

    Article  CAS  Google Scholar 

  38. Abou-Alfa, G. K. et al. Randomized phase III study of exatecan and gemcitabine compared with gemcitabine alone in untreated advanced pancreatic cancer. J. Clin. Oncol. 24, 4441–4447 (2006).

    Article  CAS  Google Scholar 

  39. Oettle, H. et al. A phase III trial of pemetrexed plus gemcitabine versus gemcitabine in patients with unresectable or metastatic pancreatic cancer. Ann. Oncol. 16, 1639–1645 (2005).

    Article  CAS  Google Scholar 

  40. Colucci, G. et al. A randomized trial of gemcitabine (G) versus G plus cisplatin in chemotherapy-naive advanced pancreatic adenocarcinoma: The GIP-1 (Gruppo Italiano Pancreas— GOIM/GISCAD/GOIRC) study. J. Clin. Oncol. 27 (Suppl. 15), a4504 (2009).

    Google Scholar 

  41. Heinemann, V., Boeck, S., Hinke, A., Labianca, R. & Louvet, C. Meta-analysis of randomized trials: Evaluation of benefit from gemcitabine-based combination chemotherapy applied in advanced pancreatic cancer. BMC Cancer 8, 82 (2008).

    Article  Google Scholar 

  42. Sultana, A. et al. Systematic review, including meta-analyses, on the management of locally advanced pancreatic cancer using radiation/combined modality therapy. Br. J. Cancer 96, 1183–1190 (2007).

    Article  CAS  Google Scholar 

  43. Boeck, S. & Heinemann, V. Second-line therapy in gemcitabine-pretreated patients with advanced pancreatic cancer. J. Clin. Oncol. 26, 1178–1179 (2008).

    Article  Google Scholar 

  44. Demols, A. et al. Gemcitabine and oxaliplatin (GEMOX) in gemcitabine refractory advanced pancreatic adenocarcinoma: A phase II study. Br. J. Cancer 94, 481–485 (2006).

    Article  CAS  Google Scholar 

  45. Tsavaris, N. et al. Second-line treatment with oxaliplatin, leucovorin and 5-fluorouracil in gemcitabine-pretreated advanced pancreatic cancer: A phase II study. Invest. New Drugs 23, 369–375 (2005).

    Article  CAS  Google Scholar 

  46. Cantore, M. et al. Combined irinotecan and oxaliplatin in patients with advanced pre-treated pancreatic cancer. Oncology 67, 93–97 (2004).

    Article  CAS  Google Scholar 

  47. Xiong, H. Q. et al. Phase 2 trial of oxaliplatin plus capecitabine (XELOX) as second-line therapy for patients with advanced pancreatic cancer. Cancer 113, 2046–2052 (2008).

    Article  CAS  Google Scholar 

  48. Pelzer, U. et al. A randomized trial in patients with gemcitabine refractory pancreatic cancer.Final results of the CONKO 003 study [abstract]. J. Clin. Oncol. 26 (Suppl.), a4508 (2008).

    Article  Google Scholar 

  49. Welch, S. A. & Moore, M. J. Combination chemotherapy in advanced pancreatic cancer: Time to raise the white flag? J. Clin. Oncol. 25, 2159–2161 (2007).

    Article  Google Scholar 

  50. Lemoine, N. R. et al. Ki-ras oncogene activation in preinvasive pancreatic cancer. Gastroenterology 102, 230–236 (1992).

    Article  CAS  Google Scholar 

  51. Van Cutsem, E. et al. Phase III trial of gemcitabine plus tipifarnib compared with gemcitabine plus placebo in advanced pancreatic cancer. J. Clin. Oncol. 22, 1430–1438 (2004).

    Article  CAS  Google Scholar 

  52. Lobell, R. B. et al. Evaluation of farnesyl: protein transferase and geranylgeranyl: protein transferase inhibitor combinations in preclinical models. Cancer Res. 61, 8758–8768 (2001).

    CAS  PubMed  Google Scholar 

  53. Jones, L., Ghaneh, P., Humphreys, M. & Neoptolemos, J. P. The matrix metalloproteinases and their inhibitors in the treatment of pancreatic cancer. Ann. NY Acad. Sci. 880, 288–307 (1999).

    Article  CAS  Google Scholar 

  54. Bramhall, S. R., Rosemurgy, A., Brown, P. D., Bowry, C. & Buckles, J. A. Marimastat as first-line therapy for patients with unresectable pancreatic cancer: A randomized trial. J. Clin. Oncol. 19, 3447–3455 (2001).

    Article  CAS  Google Scholar 

  55. Bramhall, S. R. et al. A double-blind placebo-controlled, randomised study comparing gemcitabine and marimastat with gemcitabine and placebo as first line therapy in patients with advanced pancreatic cancer. Br. J. Cancer 87, 161–167 (2002).

    Article  CAS  Google Scholar 

  56. Moore, M. J. et al. Comparison of gemcitabine versus the matrix metalloproteinase inhibitor BAY 12–9566 in patients with advanced or metastatic adenocarcinoma of the pancreas: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J. Clin. Oncol. 21, 3296–3302 (2003).

    Article  CAS  Google Scholar 

  57. Seo, Y., Baba, H., Fukuda, T., Takashima, M. & Sugimachi, K. High expression of vascular endothelial growth factor is associated with liver metastasis and a poor prognosis for patients with ductal pancreatic adenocarcinoma. Cancer 88, 2239–2245 (2000).

    Article  CAS  Google Scholar 

  58. Kindler, H. L. et al. Phase II trial of bevacizumab plus gemcitabine in patients with advanced pancreatic cancer. J. Clin. Oncol. 23, 8033–8040 (2005).

    Article  CAS  Google Scholar 

  59. Kindler, H. L. et al. A double-blind, placebo controlled, randomized phase III trial of gemcitabine (G) plus bevacizumab (B) versus gemcitabine (G) plus placebo (P) in patients with advanced pancreatic cancer (PC). A preliminary analysis of cancer and Leukemia Group B (CALGB) 80303 [abstract]. J. Clin. Oncol. 25 (Suppl.), a4508 (2007).

    Google Scholar 

  60. Vervenne, W. et al. A randomized, double-blind, placebo controlled, multicenter phase III trial to evaluate the efficacy and safety of adding bevacizumab to erlotinib and gemcitabine in patients with metastatic pancreatic cancer [abstract]. J. Clin. Oncol. 26 (Suppl.), a4507 (2008).

    Article  Google Scholar 

  61. Spano, J. P. et al. Efficacy of gemcitabine plus axitinib compared with gemcitabine alone in patients with advanced pancreatic cancer: an open-label randomised phase II study. Lancet 371, 2101–2108 (2008).

    Article  CAS  Google Scholar 

  62. Ueda, S. et al. The correlation between cytoplasmic overexpression of epidermal growth factor receptor and tumor aggressiveness: Poor prognosis in patients with pancreatic ductal adenocarcinoma. Pancreas 29, E1–E8 (2004).

    Article  Google Scholar 

  63. Bruns, C. J. et al. Blockade of the epidermal growth factor receptor signaling by a novel tyrosine kinase inhibitor leads to apoptosis of endothelial cells and therapy of human pancreatic carcinoma. Cancer Res. 60, 2926–2935 (2000).

    CAS  PubMed  Google Scholar 

  64. Moore, M. J. et al. Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J. Clin. Oncol. 25, 1960–1966 (2007).

    Article  CAS  Google Scholar 

  65. Moore, M. J. et al. The relationship of K-ras mutations and EGFR gene copy number to outcome in patients treated with erlotinib on National Cancer Institute of Canada Clinical Trials Group trial study PA.3. J. Clin. Oncol. 25 (Suppl. 18), a4521 (2007).

    Google Scholar 

  66. Siena, S., Sartore-Bianchi, A., Di Nicolantonio, F., Balfour, J. & Bardelli, A. Biomarkers predicting clinical outcome of epidermal growth factor receptor-targeted therapy in metastatic colorectal cancer. J. Natl Cancer Inst. 101, 1308–1324 (2009).

    Article  CAS  Google Scholar 

  67. Xiong, H. Q. et al. Cetuximab, a monoclonal antibody targeting the epidermal growth factor receptor, in combination with gemcitabine for advanced pancreatic cancer: a multicenter phase II trial. J. Clin. Oncol. 22, 2610–2626 (2004).

    Article  CAS  Google Scholar 

  68. Philip, P. et al. Phase III study of gemcitabine [G] plus cetuximab [C] versus gemcitabine in patients [pts] with locally advanced or metastatic pancreatic adenocarcinoma [PC]: SWOG S0205 study [abstract]. J. Clin. Oncol. 25, a4509 (2007).

    Article  Google Scholar 

  69. Schinchi, H. et al. Length and quality of survival after external-beam radiotherapy with concurrent continuous 5-fluorouracil infusion for locally unresectable pancreatic cancer. Int. J. Radiat. Oncol. Biol. Phys. 53, 146–150 (2002).

    Article  Google Scholar 

  70. Moertel, C. G., Frytak, S. & Hahn, R. G. Therapy of locally unresectable pancreatic carcinoma: a randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5-fluorouracil. The Gastrointestinal Tumor Study Group. Cancer 48, 1705–1710 (1981).

    Article  CAS  Google Scholar 

  71. Cohen, S. J. et al. A randomized phase III study of radiotherapy alone or with 5-fluorouracil and mitomycin-C in patients with locally advanced adenocarcinoma of the pancreas: Eastern cooperative oncology group study E8282. Int. J. Radiat. Oncol. Biol. Phys. 62, 1345–1350 (2005).

    Article  CAS  Google Scholar 

  72. [No authors listed] Treatment of locally unresectable carcinoma of the pancreas: Comparison of combined-modality therapy (chemotherapy plus radiotherapy) to chemotherapy alone. Gastrointestinal Tumour Study Group. J. Natl Cancer Inst. 80, 751–755 (1988).

  73. Hazel, J. J., Thirlwell, M. P., Huggins, M., Maksymiuk, A. & MacFarlane, J. K. Multi-drug chemotherapy with and without radiation for carcinoma of the stomach and pancreas: a prospective randomized trial. J. Can. Assoc. Radiol. 32, 164–165 (1981).

    CAS  PubMed  Google Scholar 

  74. Klaassen, D. J., MacIntyre, J. M., Catton, G. E., Engstro, P. F. & Moertel, C. G. Treatment of locally unresectable cancer of the stomach and pancreas: A randomized comparison of 5-fluorouracil alone with radiation plus concurrent and maintenance 5-fluorouracil–an Eastern Cooperative Oncology Group study. J. Clin. Oncol. 3, 373–378 (1985).

    Article  CAS  Google Scholar 

  75. Chauffert, B. et al. Phase III trial comparing intensive induction chemoradiotherapy (60 Gy, infusional 5-FU and intermittent cisplatin) followed by maintenance gemcitabine with gemcitabime alone for locally advanced pancreatic cancer. Definitive results of the 2000–01 FFCD/SFRO study. Ann. Oncol. 19, 1592–1599 (2008).

    Article  CAS  Google Scholar 

  76. Loehrer, P. J. et al. A randomized phase III study of gemcitabine in combination with radiation therapy versus gemcitabine alone in patients with localized, unresectable pancreatic cancer: E4201 [abstract]. J. Clin. Oncol. 26 (Suppl. 214), a4506 (2008).

    Article  Google Scholar 

  77. Krishnan, S. et al. Induction chemotherapy selects patients with locally advanced, unresectable pancreatic cancer for optimal benefit from consolidative chemoradiation therapy. Cancer 110, 47–55 (2007).

    Article  Google Scholar 

  78. Huguet, F. et al. Impact of chemoradiotherapy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase II and III studies. J. Clin. Oncol. 25, 326–331 (2007).

    Article  CAS  Google Scholar 

  79. Maitra, A. & Hruban, R. H. Pancreatic cancer. Ann. Rev. Pathol. Mech. Dis. 3, 157–188 (2008).

    Article  CAS  Google Scholar 

  80. Sian, J. et al. Core signaling pathways in human pancreatic cancer revealed by global genomic analyses. Science 321, 1801–1806 (2008).

    Article  Google Scholar 

  81. Li, C. et al. Identification of pancreatic cancer stem cells. Cancer Res. 67, 1030–1037 (2007).

    Article  CAS  Google Scholar 

  82. Lee, C. J., Dosch, J. & Simeone, D. Pancreatic cancer stem cells. J. Clin. Oncol. 26, 2806–2812 (2008).

    Article  Google Scholar 

  83. Kern, S. et al. A white paper: the product of a pancreas cancer think tank. Cancer Res. 61, 4923–4932 (2001).

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Malcolm J. Moore.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stathis, A., Moore, M. Advanced pancreatic carcinoma: current treatment and future challenges. Nat Rev Clin Oncol 7, 163–172 (2010). https://doi.org/10.1038/nrclinonc.2009.236

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrclinonc.2009.236

This article is cited by

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing