Hepatic Artery Chemotherapy for Patients With Localized Pancreas Cancer

Prior treatment

• Hepatic arterial anatomy not amenable to percutaneous access, and/or delivery of HA chemotherapy, as determined by the principal investigator and treating interventional radiologist. These may include any of the following: celiac or superior mesenteric artery occlusion; accessory or replaced hepatic arteries that cannot be ligated, divided, or embolized per the treating surgeon/interventional radiologist and would thus require more than two hepatic artery branch cannulations to treat the entire liver; any other variant anatomy deemed to have a risk of non-target GI infusion or incomplete hepatic perfusion.
• CA 19-9 \>500 within 4 weeks of planned surgical resection.
• Prior liver surgery including partial hepatectomy or transplantation.
• Recent or current active infectious disease requiring systemic antivirals, antibiotics or antifungals, or treatment within 2 weeks prior to the start of study drug, including acute or chronic active hepatitis B or hepatitis C infection, or uncontrolled HIV/AIDS. Patients with well controlled HIV are permitted. Patients receiving prophylactic antibiotics (e.g., for prevention of urinary tract infection or chronic obstructive pulmonary disease) are eligible.
• Major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to the start of study or anticipation of need for major surgical procedure during the course of the study other than surgical resection of the pancreatic tumor.
• Chronic treatment with systemic corticosteroids (\> 10 mg daily prednisone equivalents) or immunosuppressive medications
  • Intermittent steroids (\< 10 mg daily prednisone equivalents) may be used on an as needed basis (e.g. for treatment of nausea, anorexia, and fatigue)
  • Physiologic replacement doses of steroids due to adrenal insufficiency are permitted in the absence of active autoimmune disease.
  • Topical, inhaled, or intra-articular corticosteroids are allowed.
• Concurrent severe and/or uncontrolled medical conditions, which may compromise participation in the study, including impaired heart function or clinically significant heart disease

Other illness

• History of other carcinomas diagnosed within the last two years, except cured non-melanoma skin cancer, curatively treated in-situ cervical cancer, curatively treated localized thyroid cancer, or localized prostate cancer treated curatively with no evidence of biochemical or imaging recurrence.
• Serious, non-healing wound, ulcer, or bone fracture.
• History of allogenic hematopoietic stem cell transplantation.
• Known hepatitis B virus (HBV) infection (e.g., positive hepatitis B surface antigen \[HBsAg\]) or hepatitis C virus (HCV) infection (e.g., positive HCV ribonucleic acid \[RNA\]).

Lab values

• Active hepatitis or unresolved biliary obstruction at the time of diagnostic laparoscopy, as evidenced by:
  • Total bilirubin \> 1.5 x ULN
  • ALT and AST \> 2.5 x ULN

Other

• Patients will be excluded from the study if they meet any of the following criteria:
• Pregnancy or breastfeeding.
• Not willing to use an effective method of birth control.
• Liver cirrhosis.
• Participation in other interventional research protocols during the screening to 30 day follow up time-point.

• Patients are eligible to be included in the study only if they meet all of the following criteria:
• Histologically or cytologically confirmed diagnosis of PDAC, which is clinically staged as either resectable or borderline resectable after multidisciplinary evaluation.
• Age \>= 18 yo
• ECOG Performance Status 0-1
• Eligibility for FOLFIRINOX as determined by medical oncology.
• Women of child-bearing potential (i.e., women who are pre-menopausal or not surgically sterile) must use accepted contraceptive methods (abstinence, intrauterine device \[IUD\], oral contraceptive or double barrier device) during the study and must have a negative serum or urine pregnancy test within 1 week of neoadjuvant HA chemotherapy as well as during adjuvant chemotherapy as per SOC practices.
• Fertile men must practice effective contraceptive methods during the study, unless documentation of infertility exists.
• Expected survival \>3 months.
• Adequate laboratory parameters and organ function, namely:
  • Absolute neutrophil count (ANC) ≥ 1.5 x 109/L
  • Platelets ≥ 100 x 109/L
  • Hemoglobin (Hgb) ≥ 8 g/dL
  • Total bilirubin ≤ 1.5 x upper limit of normal (ULN)
  • ALT and AST ≤ 2.5 x ULN
  • Serum creatinine ≤ 1.5 x ULN or creatinine clearance (estimated) ≥ 50 cc/min by Cockroft-Gault Formula (Appendix C)
• Provide written, informed consent to participate in the study and follow the study procedures.