Of more than 30 anticancer drugs evaluated in advanced pancreatic cancer, only 5-FU has a response rate with 95 confidence intervals greater than 20. Although mitomycin-C, streptozotocin, and doxorubicin are frequently used in combination regimens, their single-agent activity in pancreatic cancer is marginal. The improved response rates initially reported in some Phase II trials of drug combinations have not been confirmed in most cooperative group trials. When partial responses are obtained, they are brief and rarely associated with clinical benefit. Median survival for combination regimens range from 3 to only 6.5 mo and are probably no longer than those obtained with 5-FU. Radiotherapy combined with 5-FU prolongs survival in patients who undergo curative resection of tumor confined to the pancreas and in those with locally advanced disease. Radiation and imaging techniques that are more sophisticated than those available at the time of the initial randomized trials are now available. More effective treatments are needed for all disease stages and may evolve as understanding of the etiology, growth regulation, and drug resistance of pancreatic cancer increases. Since results of currently available treatment are poor, patients should be offered the opportunity to participate in clinical trials.
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