Therapy for Metastatic Pancreatic Cancer

In this chapter, we provide a chronologic overview of the treatment of metastatic pancreatic ductal adenocarcinoma. We begin by enumerating landmark trials that established systemic chemotherapy as the current standard of care. In reviewing first-line and second-line systemic therapies, we note key positive and negative trials, present their primary and/or secondary endpoints and toxicity profiles, and comment on how these findings extrapolate to clinical practice. Next, we dive into molecular profiling by highlighting somatic and germline mutations, and we detail the existing research efforts on targeted therapy. Lastly, we describe future directions by analyzing on tumor-specific molecular alterations, tumor microenvironment, immunotherapy, and emphasizing the need for enrollment in clinical trials.