Study of Modified FOLFIRINOX in Advanced Pancreatic Cancer

Inclusion Criteria: * Pathologic or cytologic documentation of pancreatic adenocarcinoma * Metastatic or locally advanced unresectable disease, including borderline unresectable disease * Patients with biliary or gastroduodenal obstruction must have drainage or surgical bypass prior to starting chemoradiation * Measurable or non-measurable assessable disease * No prior treatment (chemotherapy, biological therapy, or radiotherapy) for metastatic or non-metastatic locally advanced unresectable pancreatic cancer * 6 months since completion of any prior neoadjuvant or adjuvant therapy (chemotherapy or radiotherapy) for resected pancreatic cancer * No prior treatment with oxaliplatin or irinotecan * No prior treatment with fluoruouracil or capecitabine unless administered as a radiosensitizing drug during adjuvant/neoadjuvant chemoradiotherapy after/before resection of pancreatic cancer * Patients who received chemotherapy \> 2 years ago for malignancies other than pancreatic cancer are eligible, provided that chemotherapy was completed \> 2 years ago and there is no evidence of the second malignancy at the time of study entry * \> 4 weeks since major surgery * No other concurrent anticancer therapy * ECOG Performance Status: 0-1 * Age \> 18 * No other malignancy within past two years except basal cell carcinoma of the skin, cervical carcinoma in situ, or nonmetastatic prostate cancer * Paraffin block or slides must be available * Adequate organ function * No interstitial pneumonia or extensive and symptomatic interstitial fibrosis of the lung * No \> grade 1 sensory peripheral neuropathy * No uncontrolled seizure disorder, active neurological disease, or known CNS disease * No significant cardiac disease, including the following: unstable angina, New York Heart Association class II-IV congestive heart failure, myocardial infarction within six months prior to study enrollment * No history of chronic diarrhea * Not pregnant and not nursing * No other medical condition or reason that, in the opinion of the investigator, would preclude study participation * Laboratory parameters as follows: absolute neutrophil count ≥ 1,500/uL, platelet count ≥ 100,000/uL, hemoglobin ≥ 9 g,/dL, creatinine \< 1.5 X ULN or estimated GFR \> 30 ml/min, bilirubin \< 1.5 X ULN, AST and ALT \< 3 X ULN, negative pregnancy test in women of childbearing age