Treatment of pancreatic cancer is a major oncological challenge. Pancreatic cancer remains a highly lethal disease and is the 4th leading cause of cancer-related deaths in the United States, with a 5-year survival of less than 5%. The poor prognosis of this cancer is due to its propensity for early local invasion and metastasis. Most patients present with advanced disease, precluding curative surgical resection, which remains the only potential curative approach. The adjuvant treatment may improve the prognosis in pancreatic cancer. This article presents a review of randomized clinical trials including adjuvant and neoadjuvant treatment, monotherapy and combination therapy, pain relief and the role of nutrition in pancreatic cancer treatment.