Pancreatic cancer is one of the deadliest malignancies, costing the lives of more than 30,000 patients every year. It often presents in advanced stages not amenable to surgery. Gemcitabine is currently considered to be the standard of care for the treatment of advanced pancreatic cancer. Combination of gemcitabine with certain other cytotoxic drugs, including cisplatin, oxaliplatin, capecitabine, and 5-fluorouracil have been undertaken, but all have failed to provide substantial increases in survival benefit. However, neoadjuvant algorithms and targeted therapies, including combinations of gemcitabine with erlotinib suggest more promising results. New targeted therapies in combination with gemcitabine are currently in Phase II and III trials, possibly implicating a primary position for them in future treatment. In this paper we present an overview of the current treatment options for the different presenting stages of pancreatic cancer, including adjuvant, neoadjuvant, and targeted therapies, and attempt to provide a comprehensive analysis of the disparate research indicated on this front.