Pancreatic Cancer Adaptive Neoadjuvant Chemotherapy Trial

INCLUSION CRITERIA * Be 18 years of age or older. * Be able to understand and provide written informed consent or have a legally authorized representative (LAR). * Have an Eastern Cooperative Group (ECOG) performance status \< 2 (please see the appendix). * Have documentation of histologically confirmed adenocarcinoma. Biopsy must have been completed prior to start of treatment; additional biopsy is not required for the study. * Have clinical stage consistent with resectable or borderline resectable adenocarcinoma of the pancreas, based on CT or MRI findings. * Have adequate organ and bone marrow function, as defined by: * total leukocytes \>3 x10\^3/μL. * absolute neutrophil count (ANC) \>1.5x 10\^3/μL. * hemoglobin \>9 g/dL. * platelets \>100 x 10\^3/μL. * creatinine clearance \>60 mL/min or creatinine \<1.5 mg/dL; bilirubin \< 2 mg/dL. * aspartate transaminases (AST/SGOT) and alanine transaminases (ALT/SGPT) \<3 x upper limit of normal (ULN). At two weeks from biliary decompression, if the subject's serum AST/ALT remains greater 3x ULN, but has demonstrated a progressive decline, the subject may be enrolled into the trial and appropriate modification and dose adjustments will be made to the assigned regimen. Eligibility of subjects whose AST/ALT remain elevated 3x ULN, without demonstrating a downward trend, will be determined at the discretion of the trial principal investigators. * Subjects must be CA19-9 producers as defined by a pretreatment CA 19-9 \> 35…