Immunochemoradiotherapy in Patients With Pancreatic Cancer

Inclusion Criteria:

Pancreatic adenocarcinoma proven by biopsy or cytology Locally advanced, unresectable disease with absence of distant metastatic disease. The presence of non-regional retroperitoneal or abdominal adenopathy is acceptable for inclusion.

OR

Borderline resectable pancreatic adenocarcinoma (any of the following):

* Tumor abutment or encasement of a short segment of hepatic artery (without evidence of tumor extension to the celiac artery) that is amenable to resection and reconstruction
* Tumor abutment of the superior mesenteric artery involving 180 degrees or less of the circumference of the artery and without encasement
* Impingement or narrowing of the superior mesenteric vein/portal vein or short-segment (\< 2 cm) occlusion of the superior mesenteric vein, portal vein, or their confluence with a suitable option for vascular reconstruction
* Eastern Cooperative Oncology Group(ECOG)Performance Status 0 or 1
* Ability to give informed consent and comply with the protocol
* Women of childbearing potential must have a negative pregnancy test and must avoid becoming pregnant while on treatment. Men must avoid fathering a child while on treatment.
* Patients with a history of psychiatric illness must be judged able to understand fully the investigational nature of the study and the risks associated with the therapy.

Exclusion Criteria:

* Age \< 18 years
* History of other malignancy in the past 2 years except carcinoma in situ of the cervix or bladder, or non-melanomatous skin cancer
* Previous chemotherapy or radiation therapy for pancreatic cancer or previous radiation therapy to the target field
* Clinically active autoimmune disease or active infection
* History of heart attack (within 90 days) or stroke (within 6 months), or presence of hypertension requiring change in blood pressure medications in the last 4 weeks, hypotension, uncontrolled arrhythmias, heart failure (New York Heart Association (NYHA) Functional Classification ≥ Class 2 in last 6 months), unstable angina or angina occurring during sexual activity.
* Use of "nitrates" or nitroglycerin.
* History of hereditary degenerative retinal disorders including retinitis pigmentosa.
* Chronic systemic corticosteroid use at supra-physiologic doses (prednisone \> 10 mg a day or equivalent)
* Use of recreational drugs called "poppers" like amyl nitrite and butyl nitrite.
* Laboratory values (performed within 14 days prior to enrollment) as follows:

  * Neutrophil count \< 1500 cells/µL
  * Hemoglobin \< 9 gm/dL (patients may be transfused to establish eligibility)
  * Platelet count \< 100,000 cells/µL
  * Significant coagulopathy (INR \> 1.5)
  * Significant liver or renal dysfunction
* Other medical or psychiatric conditions that in the opinion of the Principal Investigator would preclude safe participation in protocol.