Combination of Anti-PD-1 Antibody and Chemotherapy in Pancreatic Cancer

Inclusion Criteria:

• Pathologically (histologically or cytologically) confirmed pancreatic ductaladenocarcinoma (PDAC).
• No evidence of distant metastasis (such as liver, peritoneum, lung) evaluated byabdominal contrast-enhanced CT, MRI, and chest CT. PET/CT or other imagingexaminations would be used if necessary.
• Initial assessment for definitive borderline resectable or locally advanced tumors (resectability judgment is based on CT enhanced scan or magnetic resonance imaging,NCCN2019 first edition standard).
• ECOG score 0 or 1.
• Serum creatinine level is normal, and serum total bilirubin level is less than 1.5 xULN.
• ALT and AST are less than 2 x ULN.
• If biliary obstruction is observed, biliary decompression should be performed when thepatient is randomly assigned to receive neoadjuvant chemotherapy.
• Leukocyte count (> 3.5 x 10^6 /mL), neutrophil count (> 1.5 x 10^6 /mL), plateletcount (> 80 x 10^6 /mL), hemoglobin (> 9 g/dL).
• Signed informed consent.

Exclusion Criteria:

• History of malignance treatment in the past, excluding basal and cutaneous squamouscell carcinoma, cervical carcinoma in situ, papillary thyroid carcinoma
• History of participation of other clinical trails within 4 weeks
• History of immunotherapy within 4 weeks
• History of receiving chemotherapy, radiotherapy and molecular target therapy within 2weeks
• Tumor is a local recurrent lesion.
• Imaging confirmed severe portal hypertension / cavernous transformation.
• Ascites
• Gastric outlet obstruction
• Respiratory failure requires supplementation of oxygen.
• Immune deficiency syndrome, such as active tuberculosis and HIV infection.
• Hematological precancerous diseases, such as myelodysplastic syndromes.
• Major cardiovascular diseases (including myocardial infarction, unstable angina,congestive heart failure, severe uncontrolled arrhythmia) during the past six monthsof enrollment.
• Evidence of clinical-related or previous interstitial lung disease, such asnoninfectious pneumonia or pulmonary fibrosis, or baseline chest CT scan or chestX-ray findings
• Previous or physical findings of central nervous system disease, except for adequatelytreated (e.g. primary brain tumors, uncontrolled seizures or strokes with standardmedications)
• Preexisting neuropathy > 1 (NCI CTCAE).
• Allograft requires immunosuppressive therapy or other major immunosuppressivetherapies.
• Severe serious wounds, ulcers or fractures.
• Confirmed coagulant disease.
• Clinical evaluation is unacceptable.