['pancreatic adenocarcinoma']
['chemotherapy', 'gemcitabine', 'irinotecan', 'leucovorin', '5-fluorouracil', 'pembrolizumab']

        Inclusion Criteria: Each patient MUST:

          -  Have histologically confirmed advanced or metastatic pancreatic adenocarcinoma and
             have failed or did not tolerate first-line therapy.

          -  Have either archival tissue available for immune testing OR if not, a baseline biopsy
             of a primary or metastatic lesion (including ascites) which is accessible for a biopsy
             that can be accomplished with reasonable safety.

          -  Be available and agree to; a post-treatment tumor biopsy of either a primary or
             metastatic lesion (including ascites).

          -  Have measurable disease.

          -  Have no continuing acute toxic effects (except alopecia) of any prior anticancer
             treatment, i.e., all such effects must have resolved to Common Terminology Criteria
             for Adverse Events (CTCAE), version 4.02 [2], Grade ≤1. Any major surgery (except
             biopsies) must have occurred at least 28 days prior to study enrolment.

          -  Have an ECOG Performance Score ≤ 2.

          -  Have baseline laboratory results as follows:

               -  Absolute neutrophil count (ANC) ≥ 1.5 x 10E9 [SI units 10E9/L].

               -  Platelets ≥ 100 x10E9 [SI units 10E9/L] (without platelet transfusion)

               -  Serum creatinine ≤ 1.5 x ULN.

               -  Creatinine clearance (measured over 24 hours) OR calculated creatinine clearance
                  (Cockcroft-Gault formula) of ≥ 60 mL/min.

               -  Bilirubin ≤ 1.5 x ULN.

               -  AST/ALT ≤ 3 x ULN (≤ 5 x ULN if patients have liver metastasis).

               -  TSH, T4 and ACTH must be within normal range.

               -  Proteinuria with normal or grade 1 OR Urinary protein < 1 g/24hr.

               -  Negative pregnancy test for females of childbearing potential.

          -  Have signed an informed consent indicating that the patient is aware of the neoplastic
             nature of their disease and have been informed of the procedures of the protocol, the
             experimental nature of the therapy, alternatives, potential benefits, side effects,
             risks, and discomforts.

          -  Be willing and able to comply with scheduled visits, the treatment plan, and
             laboratory tests.

        Exclusion Criteria: Each patient MUST NOT:

          -  Receive concurrent therapy with any other investigational anticancer agent while on
             study.

          -  Be on immunosuppressive therapy or have known HIV infection or active hepatitis B or
             C.

          -  Receive radiotherapy within 28 days prior to receiving study drug.

          -  Be a pregnant or breast-feeding woman. Female patients of childbearing potential must
             agree to use effective contraception, must be surgically sterile, or must be
             postmenopausal. Male patients must agree to use effective contraception or be
             surgically sterile. Barrier methods are a recommended form of contraception.

          -  Have clinically significant cardiac disease (New York Heart Association, Class III or
             IV) including pre-existing arrhythmia, uncontrolled angina pectoris, myocardial
             infarction 1 year prior to study entry, or grade 2 or higher compromised left
             ventricular ejection fraction.

          -  Have dementia or altered mental status that would prohibit informed consent.

          -  Have any other severe, acute, or chronic medical or psychiatric condition or
             laboratory abnormality that may increase the risk associated with study participation
             or study drug administration or may interfere with the interpretation of study results
             and, in the judgment of the Principal Investigator, would make the patient
             inappropriate for this study.

          -  Have HIGH BURDEN/SYMPTOMATIC brain metastases. LOW VOLUME / ASYMPTOMATIC and
             pre-treated clinically stable brain metastases ARE allowed.
      