## Pancreatic Cancer Chemotherapy **Key Point:** Gemcitabine is the gold-standard first-line agent for locally advanced and metastatic pancreatic cancer, approved by FDA and recommended in NCCN guidelines. ### Rationale for Gemcitabine: - Nucleoside analogue with superior efficacy in pancreatic adenocarcinoma - Improves median survival and quality of life compared to 5-FU - Can be combined with nab-paclitaxel (ABRAXANE) for enhanced response in metastatic disease - Well-tolerated with manageable toxicity profile ### Current Standard Regimens: | Scenario | Regimen | |----------|----------| | Locally advanced | Gemcitabine ± radiation | | Metastatic | Gemcitabine + nab-paclitaxel OR FOLFIRINOX | | Adjuvant (resected) | Gemcitabine or 5-FU-based | **Clinical Pearl:** FOLFIRINOX (5-FU, leucovorin, irinotecan, oxaliplatin) is reserved for fit patients with metastatic disease due to higher toxicity; gemcitabine + nab-paclitaxel is preferred for most metastatic cases.
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