Abstract: Due to the immunosuppressive microenvironment as well as the lack of medicine that targets the driver gene alterations, the prognosis of patients with pancreatic ductal adenocarcinoma(PDAC)is worse than that of other malignant tumors.At present, chemotherapy is still the main stay of treatment for most patients with advanced PDAC. In recent years, with the continuous development of anti-cancer drugs and the wide application of next-generation sequencing technology, increasing number of studies have shown that genetic alteration could guide the selection of chemotherapy regimen and molecular targeted therapy for some patients with advanced PDAC.Guidelines of the National Comprehensive Cancer Network and Chinese Society of Clinical Oncology recommend that all patients with advanced PDAC should undergo somatic and germline genetic profiling to help determining the optimal treatment strategy and to prolong patients' survival. Therapy targeting KRAS mutation, cancer vaccines and therapy of anti-tumor metabolism are still in clinical research. This article will review current status and progress of medical treatment for advanced PDAC.