Pancreatic cancer is one of the most malignant tumors, and surgical resection is the only possible treatment to cure it. However, the 5-year survival rate for patients with early-stage pancreatic cancer who undergo surgical resection is only 15% to 20%. Moreover, more than 80% of pancreatic cancer patients are diagnosed with metastasis or in local progressive stage and cannot receive surgical treatment, and the 5-year survival rate of these patients is <5% and the 1-year survival rate is <2%. Happily, some new advances in the field of pancreatic cancer treatment in recent years have brought light to further improve the survival and quality of life of patients. Surgically resectable pancreatic cancer: Tegeo may be a new option for adjuvant chemotherapy For pancreatic cancer that can be surgically resected, the National Comprehensive Cancer Network (NCCN) guidelines currently recommend adjuvant therapy. Adjuvant chemotherapy may include gemcitabine, 5-fluorouracil (5-FU)/calcium folinic acid, 5-FU, or capecitabine. Interim results from the JASPAC-01 study were reported at the American Society of Clinical Oncology (ASCO) meeting. This non-inferiority study compared the efficacy of gemcitabine with tegeo as adjuvant chemotherapy after pancreatic cancer surgery. The results showed that the 2-year survival rates were 53% and 70% in the gemcitabine and tegeo groups, respectively (P < 0.0001), and the treatment completion rates were 58% and 72%, respectively, with milder adverse effects. The results of the study suggest that tegeo may be another option for adjuvant therapy after pancreatic cancer surgery. However, the results of this study are only the interim analysis at this time, and the publication of the final results is expected. Since the 1990s, gemcitabine has been the standard first-line chemotherapy for metastatic pancreatic cancer, and the efficacy of gemcitabine-based combination regimens has not been significantly better than gemcitabine alone in terms of overall survival (OS). 2011, the FOLFIRIN0X regimen (oxaliplatin, irinotecan, calcium folinic acid, 5-FU) became the first regimen to outperform gemcitabine in terms of OS. In 2013, studies on the first-line treatment of metastatic pancreatic cancer also yielded some promising results, adding another treatment option for clinicians. The MPACT study was first reported at the American Society of Clinical Oncology Gastrointestinal Oncology Symposium (ASCO-GI) in January 2013, where the nanoalbumin paclitaxel in combination with gemcitabine became the first chemotherapy regimen approved by the U.S. Food and Drug Administration for first-line treatment of metastatic pancreatic cancer in eight years. The results of the phase III clinical study of the combination of gemcitabine versus gemcitabine monotherapy in the first-line treatment of metastatic pancreatic cancer were published in the New England Journal of Medicine . The results showed that the primary endpoint: OS was significantly prolonged in the combination treatment group compared with the single-agent group, 8.5 months versus 6.7 months, respectively (HR=0.72, P<0.001). In people with poor physical status, age >65 years, multiple liver metastases, and high baseline ca199 levels with adverse prognostic factors, os remained beneficial or even higher. Secondary endpoints: progression-free survival (pfs) was 5.5 and 3.7 months (hr=0.69,p<0.001) in the combination treatment group and single agent group, respectively, and the overall remission rate was 23% and 7% (p<0.001). The safety results in the combination treatment group were similar to the characteristics of previous two-drug combination chemotherapy, and tolerability may be superior to that of the folfirinox regimen. Therefore, albumin-bound paclitaxel in combination with gemcitabine becomes a new standard first-line chemotherapy regimen for metastatic pancreatic cancer. further analysis of the various subgroups of the mpact study will be published in the future and is worth looking forward to. The chemotherapy has similar characteristics and may be better tolerated than the folfirinox regimen. Further results of the mpact study will be published for each subgroup in the future. In May 2013, the Journal of Clinical Oncology published the final results of the GEST study. The phase III clinical study, conducted in Japan and Taiwan, compared the efficacy of gemcitabine alone, tegeo alone, and gemcitabine combined with pregio in the first-line treatment of locally progressive pancreatic cancer and metastatic pancreatic cancer. The results showed that OS in the tegeo group was not inferior to that in the gemcitabine group (9.7 months versus 8.8 months, p < 0.001); os in the gemcitabine combined with tegeo group was not superior to that in the gemcitabine group (10.1 months versus 8.8 months, p = 0.15). The findings suggest that tegeo could be a first-line treatment for metastatic pancreatic cancer in the Asian population. First-line treatment for pancreatic cancer. <--> Locally Progressive Pancreatic Cancer: The Need to Select Appropriate Patients and Explore More Effective Treatment The treatment of patients with locally progressive pancreatic cancer in good general condition has been controversial, and NCCN guidelines recommend treatment with chemotherapy regimens for metastatic pancreatic cancer or radiation therapy in addition to adequate chemotherapy. The study randomized patients with locally progressive pancreatic cancer into two groups treated with gemcitabine alone or gemcitabine in combination with erloprim. After 4 months of treatment, the two groups of patients with stable disease were again randomized to the continued chemotherapy group and the capecitabine concurrent radiotherapy group. The final results showed that chemotherapy sequential with concurrent radiotherapy was not superior to chemotherapy alone, with OS of 15.3 and 16.5 months, respectively (P=0.83). The design of this study, however, has been questioned by some scholars, mainly in the controversial issues of failure to apply the most advanced radiotherapy techniques, failure to optimize the radiotherapy segmentation pattern, and the selection of synchronous chemotherapy drugs. Therefore, how to select suitable patients, find more effective radiotherapy sensitizing drugs, and optimize radiotherapy techniques should be the next direction to explore in the study of treatment of locally progressive pancreatic cancer. Immunotherapy for pancreatic cancer: the first signs of promise In recent years, clinical studies on immunotherapy for pancreatic cancer have emerged, and there were five clinical studies on immunotherapy for pancreatic cancer in the 2013 ASCO meeting. One of these phase III clinical trials explored the efficacy of the telomerase vaccine GV1001 in combination with chemotherapy (gemcitabine/capecitabine) compared with chemotherapy alone in the first-line treatment of metastatic pancreatic cancer. Although the study did not yield positive results, it is an exploratory clinical study of new targets and drugs for the treatment of pancreatic cancer and should be given more attention. Two promising drugs in the field of pancreatic cancer immunotherapy, GVAX and Algenpantucel-L, are both currently in phase III clinical studies. Conclusion: In 2013, some progress has been made in the field of pancreatic cancer treatment, but the expected efficacy is still far from reach. With the development of molecular biology, the understanding of the molecular mechanism of pancreatic cancer occurrence and development has been gradually deepened, which makes the connection between clinical medicine and basic medicine closer. The future development direction of pancreatic cancer diagnosis and treatment is to research new diagnostic and therapeutic targets for pancreatic cancer and implement individualized treatment strategies based on multidisciplinary comprehensive diagnosis and treatment, so as to finally achieve the goal of conquering pancreatic cancer.