Pancrelipase in People With Pancreatic Ductal Adenocarcinoma (PDAC)

Inclusion Criteria: * Histopathologic or cytologic diagnosis of pancreatic adenocarcinoma, or adenosquamous cancer, or any non-neuroendocrine primary pancreas variant, including acinar cancer. * De novo or recurrent diagnosis of previously untreated stage IV PDAC with intent to receive FOLFIRINOX/mFOLFIRINOX. * ECOG 0-2. * No use of pancreatic enzyme replacement therapy within prior 2 weeks. * Patients with biliary obstruction are eligible provided biliary stenting has or will occur before treatment with FOLFIRINOX. * Ability to understand and the willingness to sign an informed consent document. * Ability to swallow capsules. * Age ≥18 years. * Anticipated life expectancy of at least 6 months. Exclusion Criteria: * Chronic illness associated with malabsorption (celiac disease, cystic fibrosis, chronic pancreatitis, Crohn's disease). * Fibrosing colonopathy. * Prior history of surgical resection of the pancreas or gastric bypass. * History of allergic reactions attributed to compounds of similar chemical or biologic composition to Pancrelipase. * Patients cannot receive radiation, IRE, or other localized therapy directed to the pancreas while on study.