The Effects of Neoadjuvant Metformin on Tumour Cell Proliferation and Tumour Progression in Pancreatic Ductal Adenocarcinoma

Inclusion Criteria: * Age greater than or equal to 18 years on the day of study consent * Pathologic diagnosis of PDAC where 2 pre-treatment core biopsy samples are available for analysis. Patients with suspected PDAC without a pathologic diagnosis must undergo confirmatory biopsy under endoscopic ultrasound guidance. * Resectable disease based on standard imaging criteria * Surgery planned ≥ 2 weeks after study entry * Eastern Cooperative Oncology Group (ECOG) performance status 0-2 * Adequate hematologic, renal, and hepatic function as measured by the following laboratory assessments conducted within 7 days prior to the initiation of study treatment: * Total bilirubin \< 1.5 times the upper limit of normal (ULN) * Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) \< 2.5 times the ULN * Lipase \< 1.5 times the ULN * Serum creatinine \< 1.5 times the ULN * Glomerular filtration rate \> 30 mL/min/1.73 m2 according to the modified diet in renal disease abbreviated formula * International normalized ratio (INR) or prothrombin time (PT; PT-INR) and partial thromboplastin time (PTT) \< 1.5 times the ULN * Platelet count \> 100000 /mm3, hemoglobin (\> 9 g/dL, absolute neutrophil count \> 1500/mm3. * Baseline fasting glucose \<13.9 mmol/L * No prior chemotherapy or radiotherapy for PDAC * Serum lactate levels within normal range assessed within 7 days prior to the initiation of study treatment MRI sub-study: * Signed informed consent for the optio…