Overcoming acquired chemo-resistance to gemcitabine: implications from the perspective of multi-modal therapy including surgery for pancreatic cancer

Gemcitabine has been used as a key drug for the treatment of pancreatic ductal adenocarcinoma. Although surgery remains the mainstay for cure of this lethal disease, the effect is quite limited, even for resectable disease, if there is no collaboration with chemotherapy. In the cases with unresectable disease, conversion surgery after a favorable response to chemotherapy might show encouraging results. Potentiation of chemotherapeutic agent is urgently needed in almost all stages of pancreatic cancer. Further efforts must be paid on overcoming chemo-resistance by understanding tumor diversity and developing biomarkers that follow recent success of modified conventional agents by drug delivery technology.