Testing the Use of the Usual Chemotherapy Before and After Surgery for Removable Pancreatic Cancer

Inclusion Criteria:

PRE-REGISTRATION:

   - Pathology: Histologic or cytologic proof of pancreatic adenocarcinoma or adenosquamous
   carcinoma

   - TNM Stage: Tx-4, N0-1, M0 (M0 disease does not include spread to distant lymph nodes
   and organs)

   - Resectable Primary Tumor: Local radiographic reading must be consistent with
   resectable disease defined as the following on 1) arterial and venous phase
   contrast-enhanced abdominal/pelvic CT scan or abdominal/pelvic magnetic resonance
   imaging (MRI) scan and 2) chest CT:

      - No involvement or abutment of the celiac artery, common hepatic artery, superior
      mesenteric artery, or replaced right hepatic artery (if applicable)

      - Less than 180 degree interface between tumor and vessel wall of the portal vein
      or superior mesenteric vein, and patent portal vein/splenic vein confluence

      - No evidence of metastatic disease

   - Measurable disease or non-measurable disease o Non-measurable disease is defined as
   cytologic or histologic confirmation of adenocarcinoma of adenosquamous carcinoma by
   fine needle aspiration or core-biopsy of the pancreas without measurable disease by
   radiographic imaging

REGISTRATION:

   - Confirmation of resectable disease by real-time central imaging review by the Alliance
   Imaging Core Lab at Imaging and Radiation Oncology Core (IROC) Ohio

   - Determined to be appropriate candidate for curative-intent pancreatectomy by surgeon
   intending to perform the resection

   - No prior radiation therapy, chemotherapy, targeted therapy, investigational therapy,
   or surgery for pancreatic cancer

   - Not pregnant and not nursing, because this study involves an agent that has known
   genotoxic, mutagenic, and teratogenic effects.

   - Therefore, for women of childbearing potential only, a negative pregnancy test done =<
   14 days prior to registration is required

   - Eastern Cooperative Oncology Group (ECOG) performance status 0-1

   - Total Neuropathy Score < 2

   - Absolute neutrophil count (ANC) >= 1,500/uL

   - Platelet count >= 100,000/uL

   - Total bilirubin =< 1.5 x upper limit of normal (ULN) (If obstructive jaundice is
   present, then biliary drainage must be initiated and total bilirubin =< 3.0)

   - Creatinine =< 1.5 x ULN OR calculated (Calc.) creatinine clearance >= 30 mL/min
   (Calculated using the Cockcroft-Gault equation)

   - No known Gilbert's Syndrome or known homozygosity for UGAT1A1*28 polymorphism

   - No comorbid conditions that would prohibit curative-intent pancreatectomy

   - Chronic concomitant treatment with strong inhibitors of CYP3A4 is not allowed on this
   study. Patients on strong CYP3A4 inhibitors must discontinue the drug prior to
   registration

   - Chronic concomitant treatment with strong inducers of CYP3A4 is not allowed on this
   study. Patients on strong CYP3A4 inducers must discontinue the drug prior to
   registration