Since gemcitabine was first established as a standard treatment for unresectable pancreatic cancer in the 1990s, various chemotherapeutic regimens for pancreatic cancer have been investigated in Phase III studies. However, few chemotherapeutic regimens have demonstrated superior survival benefits over gemcitabine; as such, gemcitabine has been recommended as the first-choice treatment agent for a long time. Recently, the FOLFIRINOX regimen (oxaliplatin, irinotecan, 5-fluorouracil and leucovorin) and gemcitabine plus nab-paclitaxel were shown to yield a statistically significantly superior survival over gemcitabine alone in patients with metastatic pancreatic cancer. These combination treatments are now recommended as the first-line chemotherapies for pancreatic cancer in patients with a good performance status. What factors might affect the choice between these two treatments in individual patients with pancreatic cancer should also be clarified.