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Progress in treating pancreatic cancer — the fourth leading cause of cancer-related deaths in the U.S. (CA Cancer J Clin 2009; 59:225) — has been limited despite a growing number of therapies. Although gemcitabine is the standard of care for metastatic pancreatic cancer, this agent is associated with a response rate of only 6%, a median survival of 6 months, and a 1-year overall survival (OS) rate of <20%. Adding erlotinib to gemcitabine imparts modest improvement in OS at the cost of more-severe toxicity. Meta-analyses suggest that gemcitabine plus either a fluorinated pyrimidine or a platinum agent might improve outcome over gemcitabine alone in patients with good performance status, but several studies of gemcitabine combination chemothe…