Neoadjuvant CAPOXIRI Chemotherapy in the Treatment of Pancreatic Adenocarcinoma Protocol

Inclusion Criteria: 1. Histologically or cytologically confirmed diagnosis of pancreatic adenocarcinoma that is clinically staged as resectable, borderline resectable, or locally advanced as determined by CT criteria. 2. Age ≥ 18 years old. 3. An Eastern Cooperative Oncology Group (ECOG) performance status of ≤ 2 (Appendix B). 4. Patients must give written informed consent as per institutional and federal regulatory requirements. 5. An interval between initial diagnosis and consent of ≤ 42 days. 6. An interval between consent and initiating protocol-directed therapy of ≤ 14 days. 7. CT scan to stratify as resectable versus borderline resectable/locally advanced status within 28 days of initiating protocol-directed therapy. 8. A general level of health that would indicate a life expectancy of 5 years, excluding the patient's cancer diagnosis. 9. No prior chemotherapy, immunotherapy or radiotherapy for pancreatic adenocarcinoma. 10. Patients must have measurable or evaluable disease by Response Evaluation Criteria in Solid Tumors (RECIST) criteria (Appendix C). 11. Absolute granulocyte count of ≥ 1,500/mm3 and a platelet count of ≥ 100,000/mm3. 12. Patients must have adequate liver and renal function defined by a bilirubin of ≤ 2.0 mg/dL (with or without biliary stenting) and a creatinine of ≤ 1.5 mg/dL respectively. 13. Men and women who are fertile must use adequate contraception. Premenopausal women must have a negative pregnancy test documented prior to study entry. 14. There must be no extra-pancreatic spread of disease. 15. Patients must not have other serious illness or medical conditions including, but not limited to the following: New York Heart Association (NYHA) Class II or greater congestive heart failure or unstable angina pectoris, uncontrolled hypertension or arrhythmias, active bacterial infections, or unstable diabetes mellitus. 16. Patients must be disease-free of prior invasive malignancies for ≥ 5 years with the exception of curatively-treated basal cell or squamous cell carcinoma of the skin. Exclusion Criteria: 1. Patients less than 18 years of age. 2. CT evidence of metastatic disease. 3. Pregnancy or considering pregnancy at the time of study entry. 4. Breast feeding at the time of study entry. 5. Prior therapy for pancreatic cancer including irradiation, chemotherapy, or immunotherapy. 6. Receiving concurrent chemotherapy, immunotherapy, or radiotherapy that is not part of this protocol while participating in this study. 7. Receiving concurrent treatment with any other investigational drug while on this protocol. 8. Prior malignancy within 5 years, excluding squamous or basal cell carcinoma of the skin that has been effectively treated, carcinoma in situ of the cervix, lobular carcinoma in situ of the breast, or ductal carcinoma in situ of the breast. 9. Non-malignant disease that would preclude protocol participation or follow-up. 10. Myocardial infarction within 6 months before enrollment, New York Heart Association (NYHA) Class II or greater heart failure, uncontrolled angina, severe uncontrolled ventricular arrhythmias, clinically significant pericardial disease, or electrocardiographic evidence of acute ischemic or active conduction system abnormalities. 11. Psychiatric disorders or conditions, that in the opinion of the investigator, would preclude the patient from providing truly informed consent. 12. Presence of progressive sensory neuropathy or progressive hearing loss or tinnitus.