Study of Pancreatic Enzyme Replacement on Completion of Adjuvant Chemotherapy for Resected Pancreatic Adenocarcinoma

The FDA (the U.S. Food and Drug Administration) has approved Zenpep as a treatment option for
PEI. Zenpep is a combination of three enzymes (proteins). These enzymes are normally produced
by the pancreas and are important in the digestion of fats, proteins, and sugars. Zenpep is
used to replace these enzymes when the body does not have enough of its own as a result of
surgery and/or pancreatic cancer.

In this research study, the investigators are studying whether Zenpep will improve the
ability of patients to complete adjuvant treatment for their pancreatic cancer after surgery
to remove their tumor. The investigators are also studying if Zenpep will have an effect on
nutrition status and quality of life for pancreatic cancer patients after they have had
surgery to remove their tumor.

Inclusion Criteria:

- Participants must have histologically or cytologically confirmed pancreatic ductal
adenocarcinoma. Variants or mixed histology will be included if the predominant
histology is adenocarcinoma.

- Participants must have potentially resectable pancreatic cancer defined as: (1) no
detectable metastases (2) signed consent for attempted resection of pancreatic cancer
per treating surgeon.

- ECOG performance status ≤2.

- Age >18 years. Participants <18 years old are excluded from this study because
subsequent adjuvant therapy is based on therapy guidelines in the adult population.

- Willingness to consider adjuvant therapy following surgical resection of disease,
signed in the consent form attestation.

- Ability to understand and willingness to provide written informed consent.

- Pre-operative laboratory values adequate to undergo resection of pancreatic cancer, as
defined below:

- Hemoglobin > 7.0 g/dL;

- Platelets ≥ 40,000/mL;

- Creatinine < 2.5 mg/dL or; Creatinine clearance ≥ 20 mL/min/1.73 m2 for
participants with creatinine levels above institutional normal.

Exclusion Criteria:

- Pancreatic resection not performed. Intraoperative findings and unforeseen medical
exigent circumstances may preclude pancreatic resection. Such outcomes include
undetected metastases or vascular involvement, which preclude resection with intent to
cure, as well as perioperative medical events including cardiopulmonary complications.

- Final pathology other than pancreatic ductal adenocarcinoma or primary component other
than adenocarcinoma.

- Any prior chemotherapy and/or radiation for pancreatic cancer at the time of study
enrollment, including neoadjuvant chemotherapy and/or radiation therapy.

- Second malignancy with active disease.

- History of allergic reactions or hypersensitivity attributed to compounds of similar
chemical or biologic composition to pancrelipase

- Pregnant women are excluded from this study because subsequent adjuvant therapy needed
for the primary endpoint is teratogenic. Pancrelipase is category C. Animal
reproduction studies have not been conducted on pancrelipase and minimal data is
available.

- Participants unable to self-administer pancrelipase.

- Uncontrolled intercurrent illness including, but not limited to, symptomatic
congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric
illness/social situations that would limit compliance with study requirements.

- Participants who are receiving any other investigational agents.

- Participant unable to tolerate oral nutrition.