Table 1 Inclusion and exclusion criteria

• Age ≥ 18 years old and ≤ 80 years old

• Metastatic pancreatic cancer

• Histological proven pancreatic adenocarcinoma

• Patients who had surgeries, chemotherapy or other treatments before inclusion

• Borderline resectable pancreatic cancer proven by imaging examinations via multidisciplinary approaches according to NCCN guidelines

• Impaired organ functions:

A. Heart failure (New York Heart Association III–IV), coronary heart disease, myocardial infarction within 6 months, severe cardiac arrhythmia

B. Respiratory failure

• No prior chemotherapy or radiotherapy

• Confirmed other cancer within 5 years

• ECOG of 0 or 1

• Pregnant women or lactating women

• Routine blood test: absolute neutrophil count> 1500/mm³, platelet> 100,000/mm³

• Patients enrolled in other clinical trials or incompliant of regular follow up

• Normal liver function: serum total bilirubin≤2 .0mg/dl, ALT and AST < 2.5 times of the upper limit of normal value

• Patients who did not provide an informed consent

• Normal kidney function: serum creatinine< 1.5 times of the upper limit of normal value or creatinine clearance rate > 45 ml/min

• No severe comorbidities