A Study of Metformin With or Without Rapamycin as Maintenance Therapy After Induction Chemotherapy in Subjects With Pancreatic Cancer

Subjects with metastatic PDA who have received FOLFIRINOX or a gemcitabine-containing regimen
and have achieved stable disease or better will be enrolled onto this study. Subjects should
have had at least 6 months of chemotherapy and decline continuation of chemotherapy and
should have stable disease or better on 2 scans taken at least 6 weeks apart. If applicable,
subjects should also have a stable or declining CA19-9.

Twenty-two subjects will be randomized in a 1:1 ratio to metformin (Arm A) or metformin +
rapamycin (Arm B). Subjects will be stratified according to their prior chemotherapy regimen:
FOLFIRINOX or a gemcitabine-containing regimen.

Treatments will be administered orally on a 28 day cycle. Metformin will be administered
850mg twice daily and rapamycin will be administered 4mg daily.

Inclusion Criteria:

- Histologically or cytologically confirmed metastatic pancreatic adenocarcinoma.
Subjects with islet cell neoplasms are excluded.

- Have received 6 months of chemotherapy.

- Have stable disease for at least 6 months on the current regimen with the last 2 scans
taken at least 6 months apart. Measurable disease not required.

- Eastern Cooperative Oncology Group performance status 0 or 1.

- Life expectancy of greater than 12 weeks.

- Adequate organ and marrow function.

- Oxygen saturation on room air > 92 % by pulse oximetry. (Subjects on intermittent or
continuous supplemental oxygen are excluded).

- 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.

- Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

- Receiving or has received any other investigational agents within 28 days prior to Day
1 of treatment in this study.

- Has undergone major surgery, other than diagnostic surgery (i.e. surgery done to
obtain a biopsy for diagnosis or an aborted Whipple), within 28 days prior to Day 1 of
treatment in this study.

- Known history of brain metastases unless previously treated and well controlled for at
least 3 months (defined as stable clinically, no edema, no steroids).

- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to metformin or rapamycin.

- Taking ketoconazole, voriconazole, itraconazole, erythromycin, telithromycin,
clarithromycin, rifampin, rifabutin, bromocriptine, cimetidine, cisapride,
clotrimazole, danazol, diltiazem, fluconazole, protease inhibitors (e.g., HIV and
hepatitis C that include drugs such as ritonavir, indinavir, boceprevir, and
telaprevir), metoclopramide, nicardipine, troleandomycin, verapamil, carbamazepine,
phenobarbital, phenytoin, rifapentine, St. John's Wort (Hypericum perforatum), and
grapefruit juice. Subjects on metformin will not be excluded.

- Has received any non-oncology live vaccine therapy used for prevention of infectious
diseases for up to 28 days prior to or after the initiation of treatment in this
study.

- Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection (bacterial, viral, or fungal infection(s) requiring systemic therapy),
symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or
psychiatric illness/social situations that would limit compliance with study
requirements.

- Has serious medical risk factors involving any of the major organ systems such that
the Investigator considers it unsafe for the subject to receive an experimental
research drug.

- Unhealed surgical wound or other clinically significant wound.

- Known history of chronic HIV, Hepatitis B or hepatitis C infections.

- Pregnant or breast feeding.

- Unwilling or unable to comply with study procedures.

- Cannot reliably swallow pills.