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Abstract. Background: The combination of nab-paclitaxel and gemcitabine is a new effective first-line chemotherapy for patients with metastatic pancreatic cancer. This was demonstrated in the phase III MPACT trial. Patients and Methods: Four patients with metastatic pancreatic cancer from our clinical practice received combination chemotherapy with nab-paclitaxel at doses from 100 to 125 mg/m2 and gemcitabine at doses from 800 to 1,000 mg/m2 on days 1, 8 and 15 of a 28-day cycle. Two patients had elevated serum levels of total bilirubin, one older patient had significant comorbidities, another older patient had an Eastern Cooperative Oncology Group performance status of 2. Results: Treatment was manageable. Patients showed clinical remission or disease stabilization. Overall, combination chemotherapy was well tolerated. Conclusion