Nab-paclitaxel and Gemcitabine, in Elderly Patients Untreated Metastatic Pancreatic Adenocarcinoma

Inclusion Criteria:

* Histologically or cytologically-confirmed pancreatic adenocarcinoma
* Stage IV disease (metastatic only)
* No prior systemic therapy for their diagnosis (except in adjuvant setting \> six months previously)
* ECOG performance status of 0-1
* Age \>=70 years.
* Evidence of either or both of the following:

  * RECIST-defined measurable disease (lesions that can be accurately measured in at least one dimension with the longest diameter \>= 20mm using conventional techniques or \>= 10 mm with spiral CT scan)
  * An elevated serum CA19-9 at baseline ( \>= 2X ULN)
* Female patients must be either surgically sterile or postmenopausal.
* Male patients must be surgically sterile or must agree to use a condom during sex with women who may become pregnant while receiving the study drug and for 6 months after receiving the last dose.
* Adequate bone marrow function:

  * ANC \>= 1500/uL
  * platelet count \>= 100,000/uL
  * hemoglobin \>= 9.0 g/dL
* Adequate hepatic function:

  * Total bilirubin \<= 1.5 X ULN
  * AST (SGOT) \<= 2.5 X ULN
  * ALT (SGPT) \<= 2.5 X ULN
* Adequate renal function as determined by either:

  * Serum creatinine \<= 1.5 X ULN
  * Calculated or measured creatinine clearance \>= 40 mL/min (for calculated creatinine clearance, Cockroft-Gault equation will be used).
* Ability to understand the nature of this study protocol and give written informed consent
* Willingness and ability to comply with scheduled visits, treatment plans, laboratory tests, and other study procedures.

Exclusion Criteria:

* Any prior systemic or investigational therapy for metastatic pancreatic cancer.
* Inability to comply with study and/or follow-up procedures.
* History of other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that, in the opinion of the investigator, renders the subject at high risk from treatment complications or might affect the interpretation of the results of the study.
* Presence of central nervous system or brain metastases.
* Life expectancy \< 12 weeks.
* Pregnancy (positive pregnancy test) or lactation.
* Prior malignancy except for adequately treated basal cell skin cancer, in situ cervical cancer, adequately treated Stage I or II cancer from which the patient is currently in complete remission, or any other form of cancer from which the patient has been disease-free for 5 years.
* Clinically significant cardiac disease (e.g. congestive heart failure, symptomatic coronary artery disease and cardiac arrhythmias not well controlled with medication) or myocardial infarction within the last 12 months.
* Lack of physical integrity of the upper gastrointestinal tract or malabsorption syndrome.
* Known, existing uncontrolled coagulopathy.
* Pre-existing sensory neuropathy \> grade 1.
* Major surgery within 4 weeks of the start of study treatment, without complete recovery.
* Concurrent/pre-existing use of anticoagulant treatment.