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Advances in Pancreatic Cancer;Epidemiology Risk Factors Clinical Presentation Surgical Management and Adjuvant Strategies Systemic Therapy for Advanced Disease Cytotoxic Combinations Targeted Therapy;Jemal A, et al. CA Cancer J Clin. 2007;57:43-66.;;;1. Jemal A, et al. CA Cancer J Clin. 2007;57:43-66.;Pancreatic Cancer: Scope of the Clinical Problem (cont’d);Environmental exposure1 Smoking (main risk factor) Risk increases with dose and exposure Other tobacco carcinogens likely involved2 Organic and nickel-containing solvents Chlorinated compounds High BMI3 Risk higher in obese individuals Decreases with weight loss and exercise;Comorbid conditions Chronic pancreatitis Diabetes mellitus, type II1 Risk doubles with 5-year history of diabetes mellitus, type II Familial syndromes Account for 15% to 20% of cases2 1 family member affected: 18 times risk3 3 family members affected: 57 times risk;Syndrome;Component;AJCC Staging;1. Yeo CJ, et al. Ann Surg. 2002;236:355-366.;Surgery in Pancreatic Cancer: Curative Procedures;Surgery in Pancreatic Cancer: Palliative Procedures1;A Role for Adjuvant Therapy?;GITSG1 Survival advantage for chemoradiation followed by 5-FU for 1 year, but Early termination, and Slow accrual (43 patients in 8 years) EORTC2 No survival benefit for chemoradiation, but no maintenance chemotherapy;1. Neoptolemos JP, et al. NEJM. 2004;350:1200-1210.2. Oettle H, et al. J Am Med Assoc. 2007;297:267-277.;ESPAC-1: Survival;Patients with pancreatic adenocarcinoma who have undergone potentially curative resection (N = 289);Adjuvant chemoradiotherapy: lower median survival vs no chemoradiotherapy;Conventional cytotoxic agents 5-FU Gemcitabine Combination regimens Targeted therapies EGFR inhibitors Antiangiogenic agents;Gemcitabine;Gemcitabine: Common Adverse Events;Gemcitabine vs 5-FU in Unresectable Pancreatic Cancer: Clinical Trial Design;Gemcitabine vs 5-FU in Unresectable Pancreatic Cancer: Outcomes;;Many regimens have been evaluated Platinum agents Tax