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Purpose: To study the effectiveness and safety of apatinib as second-line treatment for advanced pancreatic cancer (APC) in a Chinese tertiary cancer hospital. Methods: Two groups of APC patients who received treatment with single-agent or two-drug combination of gemcitabine-based first-line therapy (50 per group) in The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing were assessed. The study group received apatinib at or above the second line treatment, while the control group was treated with second-line chemotherapy, which was different from first-line single-drug chemotherapy. Patients received treatments until there was improvement in their conditions, or until adverse reactions became intolerable. Complete remission (CR), partial remission (PR), disease stabilization (SD), disease progression (PD), incidence of adverse reactions, and progression-free survival (PFS) of the patients were recorded. Results: The number of PR cases in APC patients who received apatinib as second-line therapy, and the number of PD patients were higher than the corresponding populations in the control group (p < 0.05). Treatment effectiveness was significantly higher in study group patients than in control subjects (p < 0.05). However, the incidence of adverse reactions was lower in the study group than in control group. Median PFS in the study group (5 months) was significantly higher than that of the control group (4.1 months, p < 0.05). Conclusion: The clinical efficacy of apatinib as second-line treatment for advanced pancreatic cancer is higher than that of the single drug. Apatinib is associated with low incidence of adverse reactions which prolongs PFS. Thus, apatinib has potentials for the clinical management of pancreatic cancer. [ABSTRACT FROM AUTHOR]