Photoradiation With Verteporfin to Facilitate Immunologic Activity of Pembrolizumab in Unresectable, Locally Advanced or Metastatic Pancreatic Cancer

Inclusion Criteria

• •Age ≥ 18 years
• •Primary tumor histologically or cytologically confirmed (previously biopsied) meta-static, unresectable, or locally advanced pancreatic ductal adenocarcinoma (PDAC), including malignant transformation of a mucinous tumor \[intraductal papillary-mucinous neoplasm (IPMN) or mucinous cystic neoplasm (MCN)\]
• •* NOTE: Primary tumor in pancreas must still be present to be eligible.
• •Prior treatment for this pancreatic tumor is allowed as follows:
• •* Up to one line (≤1 regimen) of prior therapy is allowed
• •* No prior treatment with FOLFIRINOX
• •Measurable disease as defined by iRECIST. NOTE: Tumor lesions in previously irradiated area are considered measurable if previous evidence of progression has been found in these lesions
• •Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1
• •Hemoglobin ≥ 9.0 g/dL (obtained ≤ 15 days prior to registration)
• •White blood cell (WBC) ≥ 2500/mm\^3 (obtained ≤ 15 days prior to registration)
• •Absolute neutrophil count (ANC) ≥ 1500/mm\^3 (obtained ≤ 15 days prior to registration)
• •Platelet count ≥ 100,000/mm\^3 (obtained ≤ 15 days prior to registration)
• •Total bilirubin ≤ 1.5 x upper limit of normal (ULN) (obtained ≤ 15 days prior to registration)
• •Alanine aminotransferase (ALT) and aspartate transaminase (AST) ≤ 3 x ULN ( ≥ 5 x ULN for patients with liver involvement) (obtained ≤ 15 days prior to registration)
• •Prothrombin time (PT) / international normalized ratio (INR) / activated partial thromboplastin time (aPTT) ≤ x ULN (obtained ≤ 15 days prior to registration) OR if patient is receiving anticoagulant therapy then INR or aPTT is within target range of therapy
• •Creatinine ≤ 1.5 x ULN (obtained ≤ 15 days prior to registration) OR calculated creatinine clearance ≥ 50 ml/min using the Cockcroft-Gault formula
• •Negative pregnancy test done ≤ 8 days prior to registration, for persons of childbearing potential only
• •Provide written informed consent
• •Ability to complete questionnaire(s) by themselves or with assistance
• •Willingness to provide mandatory blood specimens for correlative research
• •Willingness to provide mandatory tissue specimens for correlative research
• •Willing to return to enrolling institution for follow-up (during the active monitoring phase of the study)
• •* NOTE: Patients without symptoms or prior history do not require testing prior to registration
• •History of unstable angina, new onset angina ≤ 3 months prior to registration, myocardial infarction ≤ 6 months prior to registration, or current congestive heart failure New York Heart Association class III or higher
• •Uncontrolled intercurrent illness including, but not limited to:
• •* Ongoing or active infection
• •* Current diagnosis or previous history of immune-related (non-infectious) pneumonitis or interstitial lung disease that requires or required steroids
• •* Active autoimmune disease that has required systemic treatment ≤ 2 years prior to registration (i.e., with the use of disease-modifying agents, cortico-steroids, or immunosuppressive drugs) NOTE: Replacement therapy (thyroxine, insulin, or physiologic corticosteroid replacement therapy) is allowed
• •* Any condition requiring systemic treatment with either corticosteroids ( \> 10 mg daily prednisone equivalents) or other immunosuppressive medications. NOTE: Inhaled or topical steroids and adrenal replacement doses \> 10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease
• •* Symptomatic congestive heart failure
• •* Unstable angina pectoris
• •* Cardiac arrhythmia
• •* Or psychiatric illness/social situations that would limit compliance with study requirements
• •Other active concurrent malignancy
• •* EXCEPTIONS: Non-melanotic skin cancer, carcinoma-in-situ of the cervix, papillary thyroid cancer, or other in situ cancer that has undergone potentially curative therapy
• •Receiving any other investigational agent which would be considered as a treatment for the primary neoplasm