Nab-paclitaxel and Gemcitabine Hydrochloride Followed by Radiation Therapy Before Surgery in Treating Patients With Pancreatic Cancer That Can Be Removed by Surgery

Inclusion Criteria

• Subjects must have histologically or cytologically confirmed adenocarcinoma of the pancreas
• Tumors must be localized (non-metastatic) and classified as borderline resectable according to Americas Hepato-Pancreato-Biliary Association (AHPBA)/Society of Surgical Oncology (SSO)/Society for Surgery of the Alimentary Tract (SSAT) consensus criteria or be clinically node-positive via computed tomography (CT) or endoscopic ultrasound
• AHPBA/SSO/SSAT criteria (any one of the following):
• Tumor-associated deformity of the SMV (superior mesenteric vein) or PV (portal vein)
• Abutment of the SMV or PV >= 180 degrees
• Short-segment occlusion of the SMV or PV amenable to resection and venous reconstruction
• Short-segment involvement of the hepatic artery or its branches amenable to resection and reconstruction
• Abutment of the superior mesenteric artery (SMA) = 20 mm with conventional techniques or as >= 10 mm with spiral CT scan
• No prior therapy for pancreatic cancer, including chemotherapy, radiation therapy, definitive surgery or investigational therapy
• Members of all races and ethnic groups will be included
• Eastern Cooperative Oncology Group (ECOG) performance status = = 1.5 K/cu mm
• Platelets >= 100 K/cu mm
• Hemoglobin >= 9.0 g/dL
• Total bilirubin = = 60 mL/min
• No active prior malignancy within 3 years of registration (with the exception of non-melanoma skin cancer, in-situ cancers, or Rai stage 0 chronic lymphocytic leukemia [CLL]); if patient is disease free from a prior malignancy between 3-5 years, special consideration can be requested; in these cases, if the risk of recurrence at 5 years is less than 20%, and in the opinion of the investigator the prior malignancy will not affect the patient's outcome in light of newly diagnosed pancreatic cancer, the patient may be eligible; this will require principle investigator (PI) review and approval on a case by case basis, and approval will be documented in the medical record; all patients who have been disease free from a prior malignancy for at least 5 years will be eligible
• No baseline peripheral sensory neuropathy >= grade 2
• Women of child-bearing potential and men must be willing to use adequate contraception during the entire study and for 8 weeks following completion of all chemotherapy on study; this includes hormonal or barrier method, or abstinence
• Ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria

• Subjects with locally advanced, unresectable primary tumors will not be eligible
• This includes any of the following:
• Abutment of the SMA >= 180 degrees
• Occlusion of the SMV or PV with insufficient normal vein above and below with which to perform venous reconstruction
• Involvement of the hepatic artery with insufficient artery proximal and distal to perform reconstruction
• Any prior therapy (chemotherapy, radiation or surgery) for pancreatic adenocarcinoma other than biliary decompression
• Subjects who are receiving any other investigational agents
• Subjects with known metastases
• History of allergic reactions attributed to compounds of similar chemical or biologic composition to ABRAXANE or other agents used in the study
• Active infection requiring intravenous antibiotics at the time of registration
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
• History of interstitial lung disease, idiopathic pulmonary fibrosis, silicosis, sarcoidosis or connective tissue disorders (including rheumatoid arthritis and systemic lupus erythematosus)
• Pregnant or breastfeeding women are excluded from this study
• Subjects known to be human immunodeficiency virus (HIV)-positive, including those on combination antiretroviral therapy, are ineligible because of