Minocycline Study in Pancreatic Cancer Patients

Study Groups:

If you agree to take part in this study, you will be randomly assigned (as in the flip of a
coin) to 1 of 2 groups. You will have an equal chance of being in either group:

- If you are in Group 1, you will take minocycline.

- If you are in Group 2, you will take a placebo.

Neither you nor the study staff will know if you are receiving the study drug or the placebo.
However, if needed for your safety, the study staff will be able to find out what you are
receiving.

Study Drug Administration:

Each study cycle is about 2 weeks.

You will begin taking the study drug/placebo on, or within 2 days of, Day 1 of the first
chemotherapy cycle after you are enrolled on the study. You will take the study drug/placebo
capsule by mouth, every day for up to 4 cycles (up to 8 weeks, if there are no treatment
delays).

It is possible that your chemotherapy start may be delayed if it takes additional time for
your central venous catheter (CVC) to be placed. A CVC is a sterile flexible tube that will
be placed into a large vein while you are under local anesthesia. If this happens, you may
choose to start taking the study drug/placebo up to 2 weeks before you start chemotherapy,
instead of waiting to start taking it on the same day your chemotherapy begins. You can
discuss these options with the study doctor.

You should take the study drug/placebo dissolved in a full glass (8 ounces) of water. You may
take it with or without food, but if it causes an upset stomach, you should take it with
food.

If you have trouble swallowing the dose of study drug/placebo, you can open the capsule right
before you take it. You should not lie down for at least 30 minutes after taking the study
drug/placebo to reduce the risk of side effects.

You must bring the study drug/placebo container (along with any remaining drug/placebo) to
every study visit.

Study Visits:

Before you start your treatment with the study drug/placebo:

- If you can become pregnant, blood (about 2 teaspoons) will be drawn for a pregnancy
test. If the pregnancy test is positive, it will be repeated after 48 hours to make sure
you are pregnant. Sometimes, cancer can cause a "false positive" on a pregnancy test.

- You will complete 2 questionnaires about pain and other symptoms, and your quality of
life. It should take about 5-8 minutes to complete all of the questionnaires.

- If possible, blood (about 2 tablespoons) will be drawn to test for markers of
inflammation. Markers of inflammation are found in the blood and may be related to your
symptom development.

- Your demographic information, such as your marital status, job status, education, and
race will be recorded.

Before you start your chemotherapy treatment:

°If possible, blood (about 2 teaspoons) may be drawn to test for markers of inflammation,
only if you started treatment with the study drug/placebo while you waited for your CVC to be
placed for chemotherapy. If you choose to wait to start the study drug/placebo until
chemotherapy begins, this blood sample will not be drawn.

During treatment with the study drug/placebo:

- You will complete the symptom questionnaire 2 times each week during the first cycle and
1 time each week during any remaining cycles. The symptom questionnaire asks about any
symptoms you may be having and how they may be affecting your daily activities. You will
also complete the quality of life questionnaire. The questionnaires should take about
3-5 minutes to complete each time.

- You will complete the questionnaires in paper-and-pencil format or on an electronic
tablet PC if you are in the clinic. When you are away from the clinic you will complete
the questionnaires on the telephone or on your computer.

- If possible, during your clinic visits at the start of cycle 2, 3, and 4 (if
applicable), blood (about 2 tablespoons) may be drawn to test for markers of
inflammation.

At the end of study drug/placebo treatment:

When you have finished taking the study drug/placebo, the study staff will contact you to
complete a questionnaire asking you about your opinions of the study drug/placebo. This
questionnaire will take about 3-5 minutes to complete.

Length of Study Participation:

You will be on study for up to 8 weeks, if there is no delay in starting your chemotherapy
cycles. You will take the study drug/placebo for up to 8 weeks. You will be taken off study
early if the disease gets worse, you have intolerable side effects, if you are unable to
follow study directions, or the study doctor thinks it is in your best interest.

End-of-Study Visit:

At the end of the last study cycle after you complete the symptom treatment, you will
complete questionnaires about pain and other symptoms and your quality of life. It should
take about 3-5 minutes to complete the questionnaires. If possible, blood (about 2
tablespoons) may be drawn to test for markers of inflammation.

Follow-Up:

The study staff will call you 30 days after you finish taking the study drug/placebo to ask
about any side effects you may be having. This call should last about 5 minutes.

This is an investigational study. Minocycline is FDA approved and commercially available for
the treatment of bacterial infection. Using minocycline to try to reduce the side effects of
chemotherapy in patients with pancreatic cancer is investigational.

Up to 76 patients will take part in this study. All will be enrolled at MD Anderson.

Inclusion Criteria:

1. Minocycline Trial only: Patients with a pathological or clinical diagnosis of
pancreatic cancer and beginning or continuing FOLFIRINOX or gemcitabine-based
chemotherapy.

2. Observational Arm only: Patients with a pathological or clinical diagnosis of
pancreatic cancer and beginning or continuing FOLFIRINOX chemotherapy.

3. Patients > 18 years old.

4. Minocycline Trial only: Patients with ECOG PS = 0-2.

5. Patients who speak English or Spanish (due to MDASI language options, we are only
accruing English-speaking or Spanish-speaking patients to the protocol).

6. Patients willing and able to review, understand, and provide written consent before
starting therapy.

7. Minocycline Trial only: Patients with adequate renal function according to MD Anderson
testing standards (screening cut off for serum creatinine < 2 times the upper limit of
normal).

8. Minocycline Trial only: Patients with adequate hepatic function according to MD
Anderson testing standards (screening results for total bilirubin must be < 2 times
the upper limit of normal; screening results for alanine aminotransferase (ALT) must
be < 3 times the upper limit of normal; screening results for aspartate
aminotransferase (AST), if available, must be < 3 times the upper limit of normal).

Exclusion Criteria:

1. Minocycline Trial only: Patients who are taking medication or have conditions that
potentially preclude use of minocycline, as determined by the treating physician.

2. Patients who are enrolled in other symptom management clinical trials.

3. Minocycline Trial only: Patients who currently have bile duct obstruction or
cholelithiasis.

4. Minocycline Trial only: Patients with hypersensitivity to any tetracyclines.

5. Minocycline Trial only: Patients who are pregnant. Pregnancy will be confirmed by
negative urine test; patients with a positive urine test will be retested for doubling
of HCG 48 hours after the first test, because of beta-HCG's role as a tumor marker.
Patients without such a rise will be eligible for the study and will be enrolled at
the investigator's discretion.

6. Minocycline Trial only: Patients who are under treatment of warfarin with INR > 1.5.

7. Patients who, in the judgment of the investigator, may be unable to participate in the
required study procedures.

8. Minocycline Trial only: Patients who have had prior treatment for pancreatic cancer
within the past six months may be excluded at the discretion of the investigator.