PRIMUS 001: A Study Looking at Two Different Chemotherapy Regimens in Patients With Metastatic Pancreatic Cancer

Inclusion Criteria:

1. Patient has been enrolled in the Precision-Panc Master Protocol
2. Patient has provided signed information consent for the PRIMUS 001 study
3. Age ≥ 16 years
4. Histologically-confirmed pancreatic ductal adenocarcinoma and its varients
5. Measurable metastatic disease according to RECIST V1.1
6. Eastern Cooperative Oncology Group (ECOG) 0-1 with life expectation of no less than 12weeks
7. Patients must have received no previous chemotherapy or investigational therapy forthe treatment of metastatic disease. Prior treatment with a fluoropyrimidine and/orgemcitabine administered in the adjuvant setting is allowed, provided at least 6months have elapsed since completion of the last dose and no ongoing toxicities arepresent
8. Adequate liver/bone marrow function as defined by:
9. Neutrophils (ANC) ≥ 1.5 x 109/l
10. Platelets ≥ 100 x 109/l
11. Haemoglobin ≥ 9.0 g/dL
12. White Blood Cells (WBC) ≥ 3 x 109/l
13. Total bilirubin ≤ 1.5 x institutional ULN unless bilirubin rise is due toGilbert's syndrome
14. Aspartate transaminase (AST) and alanine aminotransferase (ALT) ≤ 2.5 x ULN ( <5ULN in the presence of liver metastases)
15. Estimated creatinine clearance ≥ 60 mL/min (as calculated by Cockcroft and Gaultor Wright formula or measured by EDTA clearance) 9. Negative serum or urine HumanChorionic Gonadotropin (HCG) test for females with child bearing potential.Postmenopausal women must have been amenorrhoeic for at least 12 months to beconsidered of non-childbearing potential 10. Woman of child bearing potential,and men with female partners of child bearing potential, must agree to useadequate contraceptive measures (see s section 8.1.8.1) for the duration of thestudy and for up to 6 months after the completion of study treatment. 11.Compliant, and can be followed up regularly The following additional inclusion criteria is ONLY required if recommended by theindependent Data Monitoring Committee after interim review of study data (sites will havebeen informed by the Cancer Research UK (CRUK) Clinical Trials Unit (CTU) if this is thecase) 12. Patient must be biomarker positive as fed back after central Precision-Pancdiagnostic testing

Exclusion Criteria:

1. Prior treatment with nab-paclitaxel or oxaliplatin
2. Prior chemotherapy for metastatic pancreatic cancer
3. Known hypersensitivity for any component of any study drug
4. Active infection including Herpes Zoster and chickenpox
5. Current neuropathy ≥ grade 2
6. Uncontrolled brain metastasis
7. Uncontrolled congestive heart failure (CHF), or history of myocardial ischemia (MI),unstable angina, stroke, or transient ischemia within previous 6 months
8. Uncontrolled serious contraindicated medical condition or illness
9. Known or suspected dihydropyrimidine dehydrogenase (DPD) deficiency
10. Pregnant or breastfeeding
11. History of physical or psychiatric disorder that would prevent informed consent andcompliance with protocol
12. Administration of any investigational drug within 28 days or 5 half-lives, whicheveris longer, of receiving the first dose of trial treatment
13. Any systemic anti-cancer therapy or major surgery within 28 days of randomisation
14. Any minor surgery or radiotherapy within 7 days of randomisation
15. Any psychological, familial, sociological or geographical consideration potentiallyhampering compliance with the trial protocol and follow up schedule
16. Any patients receiving treatment with brivudin, sorivudin and analogues
17. History of another malignancy in the last 5 years (other than treated squamous/basalcell skin cancer, treated early-stage cervical cancer or treated/biochemically-stableorgan-confined prostate cancer)
18. Any patient with severe diarrhoea (defined as ≥grade 3 diarrhoea despite maximumsupportive measures and exclusion of underlying infection)