For patients with inoperable advanc

For patients with inoperable advanced pancreatic carcinoma (APC), gemcitabine monotherapy had been the standard first-line treatment with palliative intention for almost two decades [4]. Only in the last few years, new regimens were introduced which significantly improved the clinical outcomes compared with gemcitabine alone. The combination of nanoparticle albuminebound paclitaxel and gemcitabine (nab-P/G) [5] and the regimen FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan and oxaliplatin) [6] are currently considered as the standard treatment options for patients with a good performance status [7]. Because patients with elevated bilirubin levels were excluded from the phase 3 clinical studies for FOLFIRINOX and nab-P/G, both regimens are not recommended for patients with total bilirubin (TB) levels >1.5 upper limit of normal (ULN) [6,8].