Gemcitabine/Nab-Paclitaxel With HIGRT in Resectable Pancreatic Cancer

Inclusion Criteria

• Patient has signed informed consent and is willing to comply with the protocol
• Histologically or cytologically proven adenocarcinoma of the pancreas (within the last 90 days)
• Either resectable or borderline resectable as determined on staging imaging (as defined by National Comprehensive Cancer Network [NCCN])
• Patient is 18 years or older
• Karnofsky performance status 70 or greater
• The ANC count ≥ 1500, the platelet count ≥ 100,000 and hemoglobin ≥ 9g/dL
• Laboratory values meet the following constraints: Bilirubin less than or equal to 2 mg/dL; AST and ALT less than or equal to 3 x ULN (stenting to improve biliary obstruction is permitted)
• No evidence of metastatic disease based on imaging of the chest, abdomen and pelvis.

Exclusion Criteria

• Metastatic disease on pretreatment imaging
• Prior systemic therapy
• Prior abdominal radiation. Any prior radiation must be approved by the Radiation Oncology PI
• Previous treatment for pancreatic cancer
• Patients with any serious/poorly controlled medical or psychological conditions that would be exacerbated by treatment, would complicate protocol compliance
• Pregnant or lactating. Adequate birth control must be used if of child bearing potential per institutional policy. Negative pregnancy test in female patients of child-bearing potential per institutional policy. Post-menopausal women must have had amenorrhea for at least 18 months to be considered non-child bearing
• Clinically significant peripheral vascular disease
• Presence of active or chronic infection
• Clinically significant atherosclerotic cardiovascular disease including patients with New York Heart Class II/III/IV CHF, ventricular arrhythmias requiring medication, myocardial infarction, cerebrovascular accident, transient ischemic attack, coronary artery bypass grafting, angioplasty, cardiac or other vascular stenting within the past 6 months
• History of abdominal fistula, gastrointestinal perforation, intra-abdominal abscess within six months prior to treatment start
• History of collagen vascular disease or inflammatory bowel disease (Crohn's or ulcerative colitis)
• Current grade 2 or higher peripheral neuropathy
• Anticoagulation with warfarin
• History of arterial thromboembolic events or symptomatic pulmonary embolism within the past 6 months
• Active bleeding diathesis or history of major bleeding, CNS bleeding, or significant hemoptysis within the past 6 months