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, FOLF...