This review begins by discussing the anatomy and pathogenesis of exocrine pancreatic cancer and how alteration in these factors play an important role in the disease progression, and how these factors can be the target of the pharmacotherapy, and ultimately changing the outcome of the disease and improving the patient survival. It then delves into the recent advances in the pharmacotherapy, such as targeted therapies, immunotherapy, and personalized medicine approaches. The mechanisms of action, clinical trials data and potential side effects of these novel therapies are comprehensively analysed. Furthermore, this review explores the challenges and opportunities in the development of new pharmacotherapeutic regimens for exocrine pancreatic cancer.