Carboplatin and Paclitaxel With or Without Viral Therapy in Treating Patients With Recurrent or Metastatic Pancreatic Cancer

Inclusion Criteria:

• Histologically confirmed adenocarcinoma of the pancreas that is recurrent or metastatic

  • Cytological confirmation not allowed
• Paraffin-embedded tissue from tumor blocks required

• Patients must have measurable disease, defined as one lesion that can be accurately measured in at least one dimension per Response Evaluation Criteria In Solid Tumors (RECIST) 1.1 (longest diameter to be recorded) as >= 10 mm by spiral computed tomography (CT) scan (CT scan slice thickness no greater than 5 mm)

  • Malignant lymph nodes will be considered measurable if they are >= 15 mm in short axis
  • For patients previously irradiated, the measurable lesion must be outside the radiated field

• Patients must not have received any prior chemotherapy in metastatic setting; patients who have received prior chemotherapy in the adjuvant setting will not be eligible for our study;

  • Patients should not have received prior Reolysin;
  • Prior palliative radiation therapy or major surgery must have occurred at least 28 days prior to study enrollment;
  • Prior minor surgeries (such as laparoscopies) must have occurred at least 14 days prior to study enrollment;
  • Prior minor procedures such as biopsies and mediport placement must have occurred at least 48 hours prior to study enrollment
• Eastern Cooperative Oncology Group (ECOG) status =< 1 (Karnofsky >= 70%)
• Absolute neutrophil count (ANC) >= 1.5 x 10^9/L SI units
• Platelet count >= 100 x10^9/L SI units
• Hemoglobin >= 8.5 g/dL
• Serum creatinine =< 1.5 mg/dL OR creatinine clearance >= 60 mL/min
• Bilirubin =< ULN (=< 2 x upper limit of normal [ULN] if it is non-rising for a period of 10 days prior to initiation of therapy)
• Aspartete aminotransferase (AST)/alanine aminotransferase (ALT) =< 3 X ULN
• Troponin I < ULN
• All patients must have signed an informed consent indicating that they are aware of the neoplastic nature of their disease and have been informed of the procedures of the protocol, the experimental nature of the therapy, alternatives, potential benefits, side effects, risks, and discomforts
• The effects of Reolysin on the developing human fetus at the recommended therapeutic dose are unknown; for this reason and because the other chemotherapeutic agents used in this trial are known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately; patients must be able to avoid direct contact with pregnant or nursing women, infants and immunocompromised individuals while on study and for >= 3 weeks following the last dose of Reolysin administration
• All patients must be willing and able to comply with scheduled visits, the treatment plan, and laboratory tests

Exclusion Criteria:

• Patients may not be receiving any other investigational agents or concurrent therapy with other anti-cancer agents while on study
• Patients with untreated brain metastases will be excluded from this clinical trial; however, patients with resected oligometastasis are eligible if postresection magnetic resonance imaging (MRI) demonstrates resolution; gamma-knife treated patients are also eligible if there are no more than two treated metastases confined to the same area of the brain and a post treatment MRI shows a decrease in the metastases
• History of allergic reactions attributed to compounds of similar chemical or biologic composition to Reolysin or other agents used in the study
• Patients may not have received any viral-based therapy within the past 6 months
• Patients must have NO continuing acute toxic effects (except alopecia) of any prior radiotherapy, chemotherapy, or surgical procedures; all such effects must have resolved to Common Terminology Criteria for Adverse Events (CTCAE, v. 4 ) Grade =< 1 prior to study enrollment
• Patients must not have grade 2 or higher baseline peripheral neuropathy according to CTCAE v. 4
• Patients with uncontrolled cardiac dysfunction or arrhythmia, including a myocardial infarction in the preceding 6 months, known cardiac ejection fraction < 40%, symptomatic congestive heart failure, or unstable angina pectoris
• Patients must not be receiving concurrent systemic immunosuppressive therapy
• Patients must not have known human immunodeficiency virus (HIV) infection or active hepatitis B or C
• Patients must not have uncontrolled intercurrent illness including, but not limited to, ongoing or active infection or known psychiatric illness/social situations that would limit compliance with study requirements
• Patients must not have dementia or altered mental status that would prohibit informed consent
• Patients must not have other known severe, acute, or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation, study drug administration, or may interfere with the interpretation of study results that, in the judgment of the Principal Investigator, would make the patient inappropriate for this study
• Pregnant women are excluded from this study because of the potential for teratogenic or abortifacient effects; because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with Reolysin, breastfeeding should be discontinued while the mother is being treated with the agents in this clinical trial