Evaluation of the Efficacy and Safety of Neoadjuvant Therapy in Patients With Surgically Resectable Pancreatic Adenocarcinoma.

Inclusion criteria

• Adult, age ≥ 18 years old at the time of signing the informed consent form.
• Documented informed consent.
• Histologically or cytologically confirmed pancreatic adenocarcinoma.
• Tumor deemed resectable based on local assessment.
• No evidence of distant metastases on CT scan or PET scan, as well as liver MRI prior to registration.
• ECOG (Eastern Cooperative Oncology Group) performance status of 0 or 1.
• Adequate hematologic and organ function, defined by the following laboratory results obtained within 7 days prior to initiation of study treatment:

• Neutrophils ≥ 1.5 × 10⁹/L (≥ 1500/µL) without granulocyte colony-stimulating factor support.
• Platelet count ≥ 100 × 10⁹/L (≥ 100,000/µL) without transfusion.
• Hemoglobin ≥ 90 g/L (≥ 9 g/dL). Patients may be transfused to meet this criterion.
• AST, ALT, and ALP ≤ 3 × upper limit of normal (ULN).
• Total bilirubin ≤ 1.5 × ULN.Creatinine clearance ≥ 50 mL/min (calculated using the MDRD formula).
• Albumin ≥ 30 g/L (≥ 2.5 g/dL).
• For patients not receiving anticoagulant therapy: INR and aPTT ≤ 1.5 × ULN.
• Women of childbearing potential (WOCBP) must have a negative urine or serum β-HCG pregnancy test within 7 days prior to the registration. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required at 72-24 hours before starting the neo-adjuvant treatment. Sexually active female patients must agree to use two methods of effective contraception (cf. paragraph 7.10, one of them being a barrier method, or to abstain from sexual activity during the clinical investigation and for at least 6 months after last dose neoadjuvant treatment.
• Sexually active males patients must agree to use condom during the clinical investigation and for at least 6 months after the neo-adjuvant treatment. Also, it is recommended the childbearing potential female partner uses a highly effective method of contraception for the same duration (see paragraph 6.12 " Pregnancy and contraception ").
• Patients shall be eligible to undergo neo adjuvant treatment, surgery and tumor biopsies.
• Patients must be affiliated to a social security system or beneficiary of the same.
• Additional specific sub-study inclusion criteria: Patient should also meet the potential specific eligibility criteria of the sub-study for which they are screened.

Exclusion criteria

• Ongoing participation in clinical sub-study involving the use of an investigational product prior to registration in the sub-study.
• During participation in this study, patients will not receive any other clinical investigational drugs or any other anti-tumor drugs as describes on sub-study.
• Previous neoadjuvant or induction treatment for pancreatic cancer, including cytotoxic chemotherapy, immunotherapy, experimental therapy, or radiotherapy.
• Uncontrolled tumor-related pain.
• Pregnancy or breastfeeding Pregnant or breastfeeding women or intending to become pregnant during the study.
• Patient under guardianship or deprived of his liberty by a judicial or administrative decision or incapable of giving its consent.
• No prior treatment including surgery, radiation therapy or systemic therapy for pancreatic adenocarcinoma.
• Patients with a history of another primary malignancy diagnosed or requiring treatment within the 2 years prior to the first administration of the study drug. The following prior malignancies are not considered exclusion criteria, provided they have been treated with curative intent: completely resected basal cell carcinoma or squamous cell carcinoma of the skin; localized prostate cancer; superficial or non-invasive bladder cancer; or carcinoma in situ of any site.

This should be discussed with the oncologist if necessary.

• Additional specific sub-study exclusion criteria: Patient should also meet the specific eligibility criteria of the sub-study for which they are screened.