Randomized Phase II Clinical Trial of AZD6244 Hydrogen Sulfate (NSC-748727) and MK-2206 (NSC-749607) vs mFOLFOX in Patients With Metastatic Pancreatic Cancer After Prior Chemotherapy

Inclusion Criteria:

- Patients must have histologically or cytologically confirmed diagnosis of pancreatic
adenocarcinoma; patients with endocrine or neuroendocrine tumors, lymphoma of the
pancreas, or ampullary cancer are not eligible

- Patients must have distant metastatic disease; patients with macroscopic residual
disease post-resection as the only site of disease are not eligible; patients must
not have clinically significant ascites (defined as requiring paracentesis) or have
brain metastases

- Patients must have received one line, and no more than one line, of prior gemcitabine
chemotherapy for pancreatic cancer; for patients who received treatment for
advanced/metastatic disease, there must be documentation of disease progression while
on this treatment; for patients who received chemotherapy for treatment in the
adjuvant setting, recurrence to a metastatic site must be documented by imaging
studies within 6months of completing chemotherapy

- Patients must have measurable and/or non-measurable disease; x-rays, scans. or
physical examinations for assessment of measurable disease must have been completed
within 28 days prior to registration; x-rays, scans, or other tests for assessment of
non-measurable disease must have been completed within 42 days prior to registration;
all disease must be assessed and documented on the Baseline Tumor Assessment Form

- Sites must seek additional patient consent for the future use of specimens

- Zubrod performance status of 0-1

- Leukocytes >= 3,000/mcL

- Absolute neutrophil count (ANC) >= 1,500/mcL

- Platelets >= 100,000/mcL

- Hemoglobin >= 9.0 g/dL

- Patients must have adequate kidney function as evidenced by at least ONE of the
following:

- Serum creatinine =< 1.5 mg/dL within 14 days prior to registration

- Calculated creatinine clearance >= 60 mL/min; the serum creatinine value used in
the calculation must have been obtained within 14 days prior to registration

- Total bilirubin =< 1.5 times institutional upper limit of normal(IULN)

- Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) both =< 2.5 times
IULN

- Patients must have an albumin level >= 3.0 g/dL within 14 days prior to registration

- Patients must have an International Normalized Ratio (INR) =< 1.5 times IULN within
14 days prior to registration

- Patients must have an electrocardiogram (ECG) within 14 days prior to registration;
patients must have QTcF (by Fridericia's calculation) =< 450 msec (male) or =< 470
msec (female)

- Patients with baseline neuropathy must be =< grade 1 according to Common Terminology
Criteria for Adverse Events (CTCAE) v 4.0

- Patients must not have uncontrolled diarrhea or active infection requiring
antibiotics and be fully recovered from any previous serious infections within 7 days
prior to registration

- Patients must be able to swallow tablets and capsules

- Patients with diabetes must be well controlled with fasting glucose =< grade 1
according to CTCAE v 4.0 within 14 days prior to registration

- Patients with history of congestive heart failure must have an ejection fraction >=
55%within 14 days prior to registration

- Patients must not have any of the following: uncontrolled hypertension, acute
coronary syndrome within 6 months prior to registration, poorly controlled angina,
New York Heart Association Class II-IV heart failure, prior or current
cardiomyopathy, atrial fibrillation, or severe valvular heart disease

- Patients must not have a current or past history of central serous retinopathy,
retinal vein occlusion, retinal detachment, or have uncontrolled glaucoma
(irrespective of intraocular pressure [IOP])

- No prior malignancy is allowed except for the following: adequately treated basal
cell or squamous cell skin cancer, in situ cervical cancer, adequately treated stage
I or II cancer from which the patient is currently in complete remission, or any
other cancer from which the patient has been disease-free for five years

- Patients must not be pregnant or nursing due to unknown fetal and infant risks;
women/men of reproductive potential must have agreed to use an effective
contraceptive method during the study plus at least 16 weeks after last dose; a woman
is considered to be of "reproductive potential" if she has had menses at any time in
the preceding 12 consecutive months; in addition to routine contraceptive methods,
"effective contraception" also includes heterosexual celibacy and surgery intended to
prevent pregnancy (or with a side-effect of pregnancy prevention) defined as a
hysterectomy, bilateral oophorectomy or bilateral tubal ligation; however, if at any
point a previously celibate patient chooses to become heterosexually active during
the time period for use of contraceptive measures outlined in the protocol, he/she is
responsible for beginning contraceptive measures

- Patients must have completed systemic therapy at least 28 days prior to registration,
any surgical procedure must have been performed at least 14 days prior to
registration, and radiation therapy must be completed at least 7 days prior to
registration; patients must have recovered from any of the effects of prior therapies
or procedures

- Patients must not plan to receive concurrent chemotherapy, radiotherapy, laxatives,
agents known to prolong QTc interval, or agents known to be potent to Cytochrome P450
CYP3A4/5 (CYP3A4/5) or Cytochrome P450 1A2 (CYP1A2)

- Patients must not have received prior treatment with leucovorin calcium,
fluorouracil, irinotecan hydrochloride, and oxaliplatin (FOLFIRINOX), FOLFOX, MEK
inhibitors, PI3K inhibitors, or AKT inhibitors