Combination of Irinotecan, Oxaliplatin and Cetuximab for Locally Advanced or Metastatic Pancreatic Cancer

The investigators will evaluate the side effects and how well irinotecan hydrochloride,
oxaliplatin and cetuximab work in treating patients with unresectable or metastatic
pancreatic cancer. Irinotecan hydrochloride may stop the growth of tumor cells by blocking
some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as oxaliplatin,
work in different ways to stop the growth of tumor cells, either by killing the cells or by
stopping them from dividing. Monoclonal antibodies, such as cetuximab, can block tumor
growth in different ways. Some block the ability of tumor to grow and spread. Others find
tumor cells and help kill them or carry tumor-killing substances to them. Giving irinotecan
hydrochloride together with oxaliplatin and cetuximab may kill more tumor cells.

Inclusion Criteria:

1. All patients, 18 years of age or older, with histology proven pancreatic cancer are
eligible.

2. Patients must have a life expectancy of at least 12 weeks.

3. Patients must have a Zubrod performance status of 0-2.

4. Patients must sign an informed consent.

5. Patients should have adequate bone marrow function defined by an absolute peripheral
granulocyte count of >= 1,500 or cells/mm3 and platelet count >= 60,000/mm3 and
absence of a regular red blood cell transfusion requirement.

6. Patients should have adequate hepatic function with a total bilirubin <= 4.0 mg/dl,
could be <= 10 mg/ml if biliary drainage tube is placed and functional in a newly
diagnosed patient, and SGOT or SGPT <= four times the upper limit of normal, and
adequate renal function as defined by a serum creatinine <= 1.5 x upper limit of
normal.

7. For patients that had been treated with one of the study medications will be allowed
as long as the treatment did not contain more than 2 study medications at the same
time. For example, irinotecan and capecitabine combination will be allowed but not
irinotecan and cetuximab. Similarly, gemcitabine with cetuximab will be allowed but
not gemcitabine, oxaliplatin and cetuximab. Treated with irinotecan alone followed by
oxaliplatin will be allowed but not when irinotecan was in combination with
oxaliplatin.

8. Patients are allowed to have up to 2 prior treatments. The protocol will also include
chemotherapy naïve patients.

Exclusion Criteria:

1. Patients with symptomatic brain metastases are excluded from this study.

2. Pregnant women or nursing mothers are not eligible for this trial. Patients of child
bearing potential must use adequate contraception.

3. Patients may receive no other concurrent chemotherapy or radiation therapy during
this trial.

4. Patients with severe medical problems such as uncontrolled diabetes mellitus or
cardiovascular disease or active infections are not eligible for this trial.

5. Known hypersensitivity reaction to any of the study medications.