primary care clinic

Inclusion Criteria:

A patient must meet all of the following inclusion criteria to be eligible for enrollment in this study:

1. written informed consent.
2. histologically or cytologically confirmed locally advanced or metastatic adenocarcinoma of the pancreas not amenable to curative radiotherapy or surgery.
3. measurable disease as defined by Response Evaluation Criteria in Solid Tumors (RECIST) criteria (ie, target lesions that can be accurately measured in at least one dimension with the longest diameter ≥ 20 mm using conventional techniques or ≥ 10 mm using spiral computed tomography [CT] scan).
4. able to take medications orally.
5. at least18 years of age or older.
6. Karnofsky Performance Status (KPS) ≥ 70% (see Appendix A).
7. life expectancy of > 12 weeks.

8. adequate organ function as defined by the following criteria:

   • Transaminases AST (SGOT) and ALT (SGPT) ≤ 2.5 times the upper limit of normal (ULN).
   • If liver function abnormalities are due to underlying liver metastasis, then AST (SGOT) and ALT (SGPT) may be ≤ 5 times ULN.
   • Total serum bilirubin ≤ 3.0 times ULN (if due to underlying liver metastasis, then total bilirubin may be ≤ 5 times ULN).
   • Absolute granulocyte count ≥ 1,500/mm3 (ie, ≥ 1.5 x 109/L by International Units (IU]).
   • Platelet count ≥ 100,000/mm3 (IU: ≥ 100 x 109/L).
   • Hemoglobin value ≥ 9.0 g/dL.
   • Calculated creatinine clearance ≥ 60 mL/min (based on serum creatinine) (Cockcroft Gault formula).
9. willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other study procedures.
10. both female and male patients must use adequate methods of contraception.

Exclusion Criteria:

1. had treatment with any of the following within the specified time frame prior to study drug administration:

   1. Any prior anticancer chemotherapy.
   2. Radiation therapy to a target lesion unless there was evidence of PD after radiotherapy (and this target lesion must not be the only site of measurable disease).
   3. Any radiotherapy within the previous 3 weeks.
   4. Any investigational agent received either concurrently or within the last 30 days.
   5. Current enrollment in another clinical trial.
2. Major surgery within the previous 3 weeks.
3. Symptomatic brain metastasis not controlled by corticosteroids.
4. Leptomeningeal metastasis.
5. Previous or concurrent malignancy other than pancreatic cancer except adequately treated carcinoma in-situ of the cervix or non-melanoma skin cancer.
6. Uncontrolled ascites requiring drainage at least twice a week.

7. Other serious illness or medical condition(s) including, but not limited to, the following:

   • Uncontrolled congestive heart failure (New York Heart Association [NYHA]
   • Class III or IV, see Appendix F), angina pectoris, arrhythmias, or hypertension.
   • active infection.
   • known (at time of entry) gastrointestinal disorder, including malabsorption,
   • chronic nausea, vomiting, or diarrhea, present to the extent that it might interfere with oral intake and absorption of study medication.
   • Poorly controlled diabetes mellitus.
   • Psychiatric disorder that may interfere with consent and/or protocol compliance.
   • Known human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS)-related illness.
   • Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or study drug administration, or may interfere with the interpretation of study results, and in the judgment of the Investigator would make the patient inappropriate for entry into this study.
8. pregnant or lactating female.
9. known hypersensitivity to Anti-EGFR antibodies.
10. with reproductive potential who refuses to use an adequate means of contraception (including male patients).