QUILT-3.088: NANT Pancreatic Cancer Vaccine

This is a two-cohort, open-label, randomized phase 2 study to evaluate the safety and
efficacy (as assessed by PFS) of the NANT Pancreatic Cancer Vaccine regimen (experimental
arms) vs SoC therapy (control arms) as first-line treatment for subjects with metastatic
pancreatic cancer.

Subjects will be enrolled into two independent cohorts based on ECOG status. Subjects with
ECOG 0-1 will be randomized 1:1 to receive the NANT Pancreatic Cancer Vaccine regimen
(experimental arm) or gemcitabine in combination with nab-paclitaxel (control arm), while
subjects with ECOG 2 will be randomized 1:1 to receive the NANT Pancreatic Cancer Vaccine
regimen (experimental arm) or gemcitabine monotherapy (control arm).

The experimental arms will be administered in two phases, an induction and a subsequent
maintenance phase. The treatment regimen administered in the experimental arms will be
identical for all subjects, independent of ECOG status. Subjects may continue induction
treatment for up to 1 year. Those who have a complete response (CR) in the induction phase
will enter the maintenance phase of the study. Subjects who experience ongoing stable disease
(SD) or an ongoing partial response (PR) after 1 year of induction phase treatment may enter
the maintenance phase at the Investigator's discretion. Subjects may remain on the
maintenance phase of the study for up to 1 year.

Treatment in the study will be discontinued if the subject experiences confirmed PD or
unacceptable toxicity, withdraws consent, or if the Investigator feels it is no longer in the
subject's best interest to continue treatment. Subjects receiving treatment in the control
arms may cross over to treatment in the induction phase of the experimental arms after
experiencing PD. Subjects receiving treatment in the experimental arms with an initial
assessment of PD per RECIST 1.1 may, at the discretion of the Investigator, continue to
receive study treatment until PD is confirmed. The maximum time on study treatment is 2
years.

Inclusion Criteria:

1. Age ≥ 18 years old.

2. Able to understand and provide a signed informed consent that fulfills the relevant
IRB or Independent Ethics Committee (IEC) guidelines.

3. Histologically-confirmed metastatic pancreatic adenocarcinoma that has not been
previously treated with chemotherapy.

4. ECOG performance status of 0-2.

5. Have at least 1 measurable lesion of ≥ 1.0 cm.

6. If available, must be willing to release a recent formalin-fixed, paraffin-embedded
(FFPE) tumor biopsy specimen for prospective and exploratory tumor molecular
profiling. If an historic specimen is not available, the subject must be willing to
undergo a biopsy during the screening period, if considered safe by the Investigator.

7. Must be willing to provide blood samples prior to the start of treatment on this study
for prospective tumor molecular profiling and exploratory analyses.

8. Must be willing to provide a tumor biopsy specimen 8 weeks after the start of
treatment for exploratory analyses, if considered safe by the Investigator.

9. Ability to attend required study visits and return for adequate follow-up, as required
by this protocol.

10. Agreement to practice effective contraception for female subjects of child-bearing
potential and non-sterile males. Female subjects of child-bearing potential must agree
to use effective contraception for up to 1 year after completion of therapy, and
non-sterile male subjects must agree to use a condom for up to 4 months after
treatment. Effective contraception includes surgical sterilization (eg, vasectomy,
tubal ligation), two forms of barrier methods (eg, condom, diaphragm) used with
spermicide, intrauterine devices (IUDs), and abstinence.

Exclusion Criteria:

1. Serious uncontrolled concomitant disease that would contraindicate the use of the
investigational drug used in this study or that would put the subject at high risk for
treatment-related complications.

2. Systemic autoimmune disease (eg, lupus erythematosus, rheumatoid arthritis, Addison's
disease, autoimmune disease associated with lymphoma).

3. History of organ transplant requiring immunosuppression.

4. History of or active inflammatory bowel disease (eg, Crohn's disease, ulcerative
colitis).

5. Inadequate organ function, evidenced by the following laboratory results:

1. Absolute neutrophil count (ANC) < 1,000 cells/mm^3.

2. Platelet count < 75,000 cells/mm^3.

3. Total bilirubin greater than the upper limit of normal (ULN; unless the subject
has documented Gilbert's syndrome).

4. Aspartate aminotransferase (AST [SGOT]) or alanine aminotransferase (ALT [SGPT])
> 2.5 × ULN (> 5 × ULN in subjects with liver metastases).

5. Alkaline phosphatase levels (ALP) > 2.5 × ULN (> 5 × ULN in subjects with liver
metastases, or >10 × ULN in subjects with bone metastases).

6. Serum creatinine > 2.0 mg/dL or 177 μmol/L.

7. Serum anion gap > 16 mEq/L or arterial blood with pH < 7.3.

8. Medically uncorrectable grade 3 anemia (hemoglobin < 8 g/dL).

6. Uncontrolled hypertension (systolic > 160 mm Hg and/or diastolic > 110 mm Hg) or
clinically significant (ie, active) cardiovascular disease, cerebrovascular
accident/stroke, or myocardial infarction within 6 months prior to first study
medication; unstable angina; congestive heart failure of New York Heart Association
grade 2 or higher; or serious cardiac arrhythmia requiring medication. Subjects with
uncontrolled hypertension should be medically managed on a stable regimen to control
hypertension prior to study entry.

7. Serious myocardial dysfunction defined by echocardiogram (ECHO) as absolute left
ventricular ejection fraction (LVEF) 10% below the institution's lower limit of
predicted normal.

8. Dyspnea at rest due to complications of advanced malignancy or other disease requiring
continuous oxygen therapy.

9. Positive results of screening test for human immunodeficiency virus (HIV).

10. Current chronic daily treatment (continuous for > 3 months) with systemic
corticosteroids (dose equivalent to or greater than 10 mg/day methylprednisolone),
excluding inhaled steroids. Short-term steroid use to prevent IV contrast allergic
reaction or anaphylaxis in subjects who have known contrast allergies is allowed.

11. Known hypersensitivity to any component of the study medication(s).

12. Subjects taking any medication(s) (herbal or prescribed) known to have an adverse drug
reaction with any of the study medications.

13. Concurrent or prior use of a strong cytochrome P450 (CYP)3A4 inhibitor (including
ketoconazole, itraconazole, posaconazole, clarithromycin, indinavir, nefazodone,
nelfinavir, ritonavir, saquinavir, telithromycin, voriconazole, and grapefruit
products) or strong CYP3A4 inducers (including phenytoin, carbamazepine, rifampin,
rifabutin, rifapentin, phenobarbital, and St John's Wort) within 14 days before study
day 1.

14. Concurrent or prior use of a strong CYP2C8 inhibitor (gemfibrozil) or moderate CYP2C8
inducer (rifampin) within 14 days before study day 1.

15. History of receiving any investigational treatment for metastatic pancreatic cancer,
or participation in an investigational drug study within 30 days prior to screening
for this study, except for testosterone-lowering therapy in men with prostate cancer.

16. Assessed by the Investigator to be unable or unwilling to comply with the requirements
of the protocol.

17. Concurrent participation in any interventional clinical trial.

18. Pregnant and nursing women.