Adaptive Approach to Neoadjuvant Therapy to Maximize Resection Rates for Pancreatic Adenocarcinoma

Inclusion Criteria: * Diagnosis of pancreatic carcinoma or adenocarcinoma confirmed by tissue. Histologies other than carcinoma or adenocarcinoma are not allowed. * Resectable or borderline resectable primary tumor, evaluated on a baseline contrast-enhanced CT or MRI scan (CT Chest/Abdomen/Pelvis with contrast is preferred; if MRI used at baseline, then follow up with MRI as well), and defined using Intergroup criteria: * Tumor vessel wall interface 0-360 for portal and superior mesenteric veins. * Tumor vessel wall interface \<180 for celiac, common hepatic, and superior mesenteric arteries. * No suspicious metastatic lesions (no visceral lesions, no enlarged nodes outside the surgical basin). * Age ≥18 years. * ECOG performance status ≤ 1. * No prior therapy for index pancreatic cancer. * Patients must have adequate organ and marrow function as defined in protocol * Known human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial. * For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated. * Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load. * Patients with a prior malignancy (with all treatment completed…