Advanced pancreatic cancer--5 years on.

Some 5 years ago we reviewed the literature on the treatmentof advanced and metastatic pancreatic cancer. At that time gemcitabinehad recently emerged as the new standard treatment for advanceddisease based on a relatively small North American randomisedtrial, which compared gemcitabine to 5-fluorouracil (5-FU) givenby bolus injection. Gemcitabine produced superior response rate,survival and clinical benefit [1], and rapidly gained widespreaduse in North America, but the uptake in Europe was slower—thetrial had been criticised for the suboptimal schedule of 5-FU.However, the agent gradually gained clinical acceptance in Europeand with the publication of the National Institute of ClinicalExcellence (NICE) guidelines supporting gemcitabine in June2001, the UK followed suit. Moreover, during these 5 years