Stage 4 pancreatic cancer treatment centers on combination chemotherapy (FOLFIRINOX, gemcitabine/nab-paclitaxel), single-agent regimens, targeted therapies for actionable mutations, and thorough palliative care, selected primarily by performance status (ECOG 0-1 vs. 2 vs. 3-4) and treatment goals (life extension vs. Quality of life). Key Takeaways FOLFIRINOX and gemcitabine/nab-paclitaxel serve as first-line chemotherapy options, selected by ECOG performance status, age, and