Additionally, gemcitabine induces CXCR4 expression in pancreatic cancer cells indirectly by stimulating ROS [76], which in turn activates ERK1/2 and Akt and resultantly upregulates the nuclear factors NF-κB and HIF-1α that bind to and activate expression of the CXCR4 promoter. Here, CXCR4 is linked to familial pancreatic carcinoma.