Palliative chemotherapy in pancreatic cancer—treatment sequences

Pancreatic cancer belongs to the most deadly malignancies and is expected to become the second deadliest cancer by 2040. Still, in most of the cases the tumor is detected in a nonresectable or metastatic state and, untreated, the disease will progress rapidly. Even with chemotherapeutic treatment the prognosis is poor and the 5-year overall survival rate is less than 10%. Therefore, there is a need for proper therapeutic options for the palliative treatment of the disease. Despite great efforts to find new drugs for the treatment of pancreatic cancer, for a long time the therapy was limited to the use of gemcitabine with very limited benefit. Recently new chemotherapeutic regimens have been identified that helped to improve the overall survival significantly. In addition, even second-line therapies have been established. This review will provide an overview on the current standard of care, discusses possible treatment sequences and offer a perspective on future developments.