OBJECTIVES:  According to a recent epidemiological study, pancreatic cancer is fourth most fatal cancer in men and women across Europe. A 19% increase in deaths associated with pancreatic cancer was observed from 2009 to 2014 in Europe. This review was aimed to assess the clinical practice guidelines and treatment patterns in metastatic pancreatic cancer in EU-5 countries i.e. the UK, Germany, Spain. France, and Italy. METHODS:  Embase^® and MEDLINE^® were searched for relevant studies providing clinical guidelines and real-world patterns for treatment of patients with pancreatic cancer, published post 2006. RESULTS: Of the 271 citations identified (treatment guidelines: 66 and treatment patterns: 205), 10 studies met the inclusion criteria (treatment guidelines: 7 studies and treatment pattern: 3 studies) Two guidelines were identified for the UK, while one each clinical guideline was identified for Spain, Germany, Italy, and France and one guideline was identified for Europe. Gemcitabine is considered as the standard of care for the treatment of patients with metastatic pancreatic cancer across EU-5 countries. Similar treatment recommendations were observed across the guidelines; recommended first-line treatment options include FOLFIRINOX, gemcitabine plus nab-paclitaxel, gemcitabine plus erlotinib, gemcitabine-capecitabine or gemcitabine monotherapy. However, best supportive care is recommended for the patients with PS of 3 or 4, even chemotherapy is not recommended for these patients. Real-world treatment pattern also showed that gemcitabine alone was most commonly administered for treating metastatic pancreatic cancer (UK: 46%; France: 46.5%; Germany: 41.5%) followed by FOLFIRINOX (UK: 20.1%; France: 28.3%). CONCLUSIONS:  Gemcitabine based therapies are recommended treatment options for metastatic pancreatic cancer. Treatment pattern were similar across EU-5 countries and aligned with clinical practice guidelines. Further research need to be conducted to comprehensively characterize pancreatic treatment patterns in the EU-5