Pancreatic cancer is one of the most lethal cancers and will become the second leading cause of cancer-death; despite some progress in management, median survival remains around 24 months in resected disease, fifteen months in locally advanced non resectable disease and twelve months in metastatic setting. Two backbone regimens, folfirinox and gemcitabine-abraxane are nowadays used in routine practice, mainly in metastatic disease but are now investigated in both adjuvant and neo-adjuvant therapy. Neoadjuvant therapy, although requiring robust proof of definite efficacy, is more frequently used for borderline resectable tumours with promising results; moreover, it offers a unique window to integrate care and research by assessing new drugs in translational platforms. Molecular biology (multiomics) and imaging (radionomics) will also permit and promote a more comprehensive use of new drugs, including immune-oncological ones and strategies and select the best patients for precision medicine, the ultimate goal being to improve this poor outcome. This review covers the current standard and best practice in the different sub-entities of pancreatic cancer and opens perspectives in new therapeutic challenges.

(BELG J MED ONCOL 2018;12(2):39–45)