ADJUVANT: So has there been progress in therapy for pancreatic cancer? Yes and no! Appears that the best current therapy as an add on (adjuvant) to surgical removal is a combination of capecitabine (oral) and gemcitabine (intravenous).

THERAPY for METASTATIC Disease: FOLFIRINOX (a derivative of FOLFOXIRI (used initially in Italy for colorectal cancer) is the therapy with highest reported response rate however this is associated with significant side effects and requires insertion of a central venous port and use of an ambulatory infusion pump.

Elderly patients may wish to use single agent therapies such as 5-FU or gemcitabine (less effective than FOLFIRINOX.

Glenn Tisman, M.D.