Inclusion Criteria:

• Histologically proven pancreatic ductal adenocarcinoma or adenosquamous carcinoma.
• Any treatment line for palliative systemic therapy for locally advanced unresectable and/or metastatic disease.
• Performance status 0-2.
• Prior neoadjuvant or adjuvant chemotherapy, peri-operative or palliative radiotherapy, and curative or palliative surgical attempts are permitted.
• Medically determined fit patient to receive systemic chemotherapy protocols.
• Adequate marrow (hematologic) and organ function (mainly renal and hepatic) determined by treating physician to participate on the patient preferred treatment strategy.
• Patient with child-bearing potential must discuss effective contraception with treating physician according to discuss potential risk on treatment strategy.
• Interval since baseline laboratory (mainly CA 19-9) and imaging (mainly CT or MRI measurable disease) < 4 weeks from enrollment.
• Patient information and signed informed consent.
• Public or private health insurance coverage.
• Life expectancy greater than 2 months.
• No active concurrent secondary malignancy diagnosis.
• No serious medical or physiological condition precluding participation.

Exclusion Criteria: 

• Other types of non-ductal tumor of the pancreas, including endocrine tumors or acinar cell adenocarcinoma, cyst adenocarcinoma, ampullary carcinoma, lymphoma or other.
• Patient with significant co-morbidities (e.g. heart failure NYHA iii/iv or active coronary syndrome) or active infection (e.g. HIV or chronic hepatitis B or C) or uncontrolled chronic degenerative disease (e.g. diabetes) that may preclude the delivery of treatment determined by treating physician.
• Psychological, familial, sociological or geographical impeding compliance.
• Pregnancy or breast feeding.

Eligibility last updated 7/13/22. Questions regarding updates should be directed to the study team contact.