Pancreaze (Pancrelipase) for Patients With Pancreatic Adenocarcinoma With Cachexia and Exocrine Pancreatic Insufficiency

Inclusion Criteria:

1. Borderline resectable, locally advanced, and advanced pancreatic cancer patients (can include new or recurrent diagnosis) referred to SOCCI-CSMC (Samuel OschinCancer Center - Cedars Sinai Medical Center)

2. Age ≥ 18 years.

3. ECOG performance status 0-1 or Karnofsky PS >60%

4. Clinical diagnosis of exocrine pancreatic insufficiency

5. Cachexia defined as at least 5% weight loss in the presence of chronic illness,within any 6-month period prior to screening OR as documented by the medicalphysician based on standard diagnosis of cachexia

6. Life expectancy of greater than 3 months, in the opinion of the investigator.

7. Patients must have normal organ and marrow function as defined below:

• Absolute Neutrophil Count (ANC) ≥ 500/mcL

• Platelets ≥ 50,000/mcL

• Total bilirubin ≤ 5X upper limit of normal (ULN)

• AST(SGOT)/ALT(SGPT) ≤ 5 X ULN

• Creatinine OR creatinine clearance ≤ 3 times the upper limit of normal OR ≥ 30mL/min/1.73 m² for patients with creatinine levels above normal.

• Note: Patients with biliary stents are eligible provided that all otherinclusion criteria are met.

8. Woman of child-bearing potential (WOCBP) and men must agree to use adequatecontraception (hormonal or barrier method of birth control; abstinence) from thetime of signing the informed consent form, for the duration of study participation,and for at least 30 days after discontinuing from study treatment.

9. Ability to understand and the willingness to sign a written informed consentdocument

Exclusion Criteria:

1. Uncontrolled intercurrent illness including, but not limited to, ongoing or activeinfection, symptomatic congestive heart failure, unstable angina pectoris, cardiacarrhythmia, or psychiatric illness/social situations that would limit compliancewith study requirements.

2. Women who are pregnant or are breastfeeding

3. Dementia or altered mental status that would prohibit the understanding or renderingof informed consent

4. Unable to swallow intact capsules

5. Fibrosing colonopathy: Patients with history of fibrosing colonopathy have beenreported to experience advancement to colonic strictures with doses of lipase>6000units/kg/meal over prolonged periods of time.

6. History of chronic illness associated with malabsorption or nutrient deficiencyincluding but not limited to chronic pancreatitis, cystic fibrosis, celiac disease,Crohn's disease, pernicious anemia and/or prior intestinal resection.

7. Coexistent other primary malignancy

8. Pregnancy, breastfeeding, or of childbearing potential and not willing to usemethods of birth control during the study

9. Active drug abuse or intoxication with any substance including alcohol (bloodalcohol content >0.08%, legal driving limit)

10. Known allergy to any of the active ingredients in pancreatic enzyme supplementation

11. Concurrent use of pancreatic enzyme supplementation or over the counter supplementswhich contain lipase, protease, and amylase as active ingredients