What would be your frontline therapeutic choice for a patient with Stage IV pancreatic adenocarcinoma with good PS but elevated bilirubin (4-5) due to tumor volume?

This is a difficult question. Treating advanced pancreatic cancer patients with significant organ dysfunction may not be appropriate when one considers the response rates of 20-30% in the first line setting and a poor overall prognosis. However, if a pateint has a good performance status, FOLFOX seems like an appropriate regimen. Gemcitabine and abraxane could also be used and dose adjustements should be considered.