Introduction: This study is to evaluate the outcome of patients with locally advanced and metastatic pancreatic cancer treated with continuous infusion of low dose gemcitabine. Patients were recruited from oncology outpatient clinic, Sohag University and South Egypt Cancer Institute. Methods: From December 2013, to October 2014, 26 patients with locally advanced or metastatic pancreatic cancer (stage III, stage IV) histopathologically and/or radiologically confirmed diagnosis of pancreatic cancer with no prior chemotherapy for pancreatic cancer or other malignancies received continuous infusion of low dose gemcitabine (250 mg/m2) over 6 hours weekly for seven weeks and then for d1, d8 every 3 weeks till toxicity or progression. Results: Twenty six patients (19 men and 7 women) with ECOG performance status ranged between1-3 were enrolled in this study. 42.3% of patients were non smoker. Their main complaint was abdominal pain (100%) then jaundice (80.76%). As regard disease characteristics, pathological diagnosis of T3 in 15 patients (57.7%), and T4 in four patients (15.4%). Twenty one of patients (80.76%) had tumor at head of pancreas, three patients (11.5%) at the tail, two patients (7.7%) at the body of pancreas. 15 of patients (57.7%) were biopsied. After initial seven weeks response rate was 39.5% in the form of complete response in one patient (3.8%), partial response in 7 patients (26.9%), stationary response in 2 patients (7.7%), while there is disease progression in 16 patients (61.5%). Progression Free Survival (P.F.S.) was 65.38%, 23.07%, 7.69% and 3.84 (3, 6, 9 and 12 months respectively), while Overall Survival (O.S.) was 61.53%, 42.3%, 23.07% and 7.69% (3, 6, 9 and 12 months respectively). Performance status was significantly correlated with P.F.S. (p value <0.01) and biopsy taken was significantly correlated with P.F.S (p value <0.04) and also O.S. (p value <0.03). Grade III, IV neutropenia observed in 8 (36.7%), 4 (15.4%) patients respectively. Grade II, III, IV anemia occurred in 9 (34.6%), 13 (50%), 2 (7.7%) patients respectively, and grade 1, 2 thrombocytopenia in 5 (19.2%), 2 (7.7%) patients. Also non-hematological toxic effect was observed such as increased creatinine level in 6 (23.0%) patients, nausea occurred in all patients (100%), vomiting grade 1,2,3 experienced in 4 (15.3%), 12 (46.1%), 5 (19.2%) patients respectively. Conclusion: Continuous infusion of low dose gemcitabine in locally advanced and metastatic pancreatic carcinoma is safe and viable option especially in our developing countries. Performance status and biopsy taken were important significant prognostic factors.