Acelarin First Line Randomised Pancreatic Study

Inclusion Criteria: * Age ≥ 18 years. * Histologically or cytologically proven pancreatic ductal adenocarcinoma or undifferentiated carcinoma of the pancreas. * Metastatic disease precluding curative surgical resection or definitive locally directed therapies such as chemo radiation. Patients who have relapsed following previously resected pancreatic cancer can be included. * Contrast enhanced computerised tomography (CT) scan of the thorax, abdomen and pelvis within 28 days prior to commencing treatment. * Unidimensionally measurable disease. * ECOG performance status 0, 1 or 2 where combination chemotherapy is not deemed appropriate or is declined by the patient. * Platelets ≥100 x 109/l; WBC ≥ 3 x 109/l; neutrophils ≥ 1.5 x 109/l at entry. * Documented life expectancy \> 3 months. * Informed written consent. Exclusion Criteria: * Laboratory results: * Serum bilirubin ≥ 1.5x the upper limit of reference range (ULRR). * Haemoglobin \< 10G/dl. * Creatinine clearance \< 30 mL/minute (calculated by Cockcroft-Gault formula). * Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) \>2.5 x ULN or \> 5x ULN if judged by the investigator to be related to liver metastases. * Medical or psychiatric conditions compromising informed consent. * Intracerebral metastases or meningeal carcinomatosis. * Evidence of severe or uncontrolled systemic disease or any concurrent condition which in the Investigator's opinion makes it undesirable for the patient to participat…