Gemcitabine Versus Reduced-dose Combination Chemotherapy in Fragile Patients with Non-resectable Pancreatic Cancer

Who May Qualify: - Age ≥ 18 years - Adenocarcinoma of the pancreas, histopathologically or cytologically verified - Non-resectable (locally advanced or metastatic) PC - Patients unfit or not candidate for full-dose combination chemotherapy - Patients eligible for full dose gemcitabine or reduced dose combination chemotherapy - Performance status (PS) ≤2 - Measurable or non-measurable disease - Adequate hematologic function defined as absolute neutrophil count (ANC) ≥1.5 x 10\^9/l and platelets count ≥100x10\^9/l within 2 weeks prior to enrollment - your organs (liver, kidneys, etc.) are working well enough based on blood tests (bilirubin ≤1.5 x UNL (Upper Normal Limit) and eGFR (estimated Glomerular Filtration Rate) \>50ml/min within 2 weeks prior to enrollment - Toxicity of prior chemotherapy, including neurotoxicity, resolved to CTCAE \<grade 2 - Oral and written willing to sign a consent form must be obtained according to the local Ethics committee requirements - Fertile patients must use adequate contraceptives Who Should NOT Join This Trial: - Patients eligible for downstaging/preoperative chemotherapy followed by resection or local ablation or irradiation - Prior chemotherapy for PC (However, patients treated with adjuvant therapy with recurrence occurring more than 6 months after end of this treatment are eligible) - Concurrent, non-curatively treated malignant neoplasm other than pancreatic adenocarcinoma - Concurrent treatment with any other anti-cancer therapy - Pregnant or breast-feeding patients - Patients clearly intending to withdraw from the study if not randomized in the willing arm or patients who cannot be regularly followed up for psychological, social, familiar, or geographic reasons. - Other condition or therapy, which in the investigator's opinion may pose a risk to the patient or interfere with the study objectives. - Known allergy or intolerance to any of the drugs used in DPCG-01 (Gemcitabine, S1 or Nab-Paclitaxel) Always talk to your doctor about whether this trial is right for you.