ABSTRACT Aim: Pancreatic cancer is a disease seen predominantly in elderly patients (pts). However, no standards of care exist for >70y patients. We aimed at evaluating the outcome of elderly pts treated with chemotherapy for pancreatic cancer and the presence of prognostic factors in this subpopulation. Methods: We reviewed the clinical records of patients with PDAC aged ≥70y treated with chemotherapy in four Italian Oncology Units from January 2005 to April 2014. Survival estimates were quantified using Kaplan Meier curves. Tumor stage, ECOG-Performance Status (PS), pre-treatment CEA and CA 19-9, hemoglobin (Hb), neutrophil, lymphocyte and platelet count as well as LDH were included in the Cox analysis to investigate their prognostic significance. Results: 178 pts were included in this analysis. Median age was 74 years (range 70-88); 97 pts (54.5%) were males; 128 pts (71.9%) had metastatic disease. Median overall survival (OS) was 5.6 months. Median first-line PFS was 3.2 months. Folfirinox was the first-line in 10 pts (5.6%); 90 pts (50.6%) were treated with gemcitabine alone, 78 pts (43.8%) gemcitabine-based doublets, without differences in terms of OS (p = 0.07). Forty-five pts (25.2%) were treated with second-line chemotherapy; median OS of 4.2 months and a PFS of 2.2 months No differences in terms of OS and PFS were found between mono (23 pts) vs combined (22 pts) second-line chemotherapy (p = 0.42). Only 7 pts (3.9%) underwent third-line chemotherapy, with an OS of 8.1 months and a PFS of 1.7 months. At multivariate analysis, ECOG-PS ≥ 2 (p = 0.004) and lymphocyte count (p = 0.04) were independent prognostic factors for OS. Furthermore, ECOG-PS ≥ 2 (p = 0.04), Hb (p = 0.03), lymphocyte (p = 0.01) and neutrophil counts (p = 0.04) were significantly associated with PFS. Conclusions: Chemotherapy appears to have a similar activity in elderly patients as compared to younger patients with pancreatic cancer. However, combined chemotherapy does not occur to be more effective than monotherapy. Disclosure: All authors have declared no conflicts of interest.