Pancreatic Adenocarcinoma Signature Stratification for Treatment

Prior treatment

• Patients who have received prior systemic treatment for PDAC, including treatment in the neoadjuvant or adjuvant setting. Prior surgery or palliative radiation is permitted.
• Use (including 'recreational use') of any illicit drugs or other substance abuse (including alcohol) that could potentially interfere with adherence to study procedures or requirements. \*Use of any illicit drugs or other substance abuse (including alcohol) are not screened in Canada using Toxicity testing. -

Other illness

• Uncontrolled inter-current illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, inability to stop anticoagulation medication for a biopsy, or psychiatric illness/social situations that would limit compliance with study requirements.
• Any other condition that would, in the Investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns or compliance with clinical study procedures.

Other

• Patients with histology other than pancreatic ductal adenocarcinoma. Those with adenosquamous are allowed. Acinar tumors and colloid are excluded.
• Patients with one or more contraindications to tumor biopsy according to local institution's standard biopsy procedures.
• Patients with known brain metastases are excluded from participation in this clinical study.
• Patients with a known germline mutation in BRCA, PALB2 or other homologous Recombination Repair Deficiency (HRD) genes.
• Patients who are pregnant or breastfeeding.

• Patients must have a histological or radiological diagnosis of untreated metastatic PDAC at screening with histology subsequently confirmed prior to randomization.
• Eligible histologic variants include adenocarcinoma or variants to include mucinous adenocarcinoma or adenosquamous carcinoma.
• Patients with a history of prior or concurrent second primary malignancy whose natural history or treatment does not have the potential to interfere with the safety or primary endpoint efficacy assessment of the pancreas cancer should generally be eligible for enrollment in clinical trials.
• Age ≥18 years.
• Patient must have a tumor lesion that is amenable to a core needle biopsy.
• Patients must be suitable for treatment with either mFFX and GA without contraindications to either regimen.
• Eastern Cooperative Group (ECOG) performance status 0-1. (Karnofsky ≥70%).
• Life expectancy of greater than 90 days, as judged by the investigator
• Women of child-bearing potential (WOCBP) must have a negative serum pregnancy test and must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation.
• Within 14 days of the proposed randomization date, patients must have normal organ and marrow function