
    slow accrual
  
['gastro-enteropancreatic neuroendocrine tumor', 'pancreatic cancer', 'neuroendocrine carcinomas of pancreas', 'islet cell carcinoma']
['folfirinox', 'granulocyte colony-stimulating factor (g-csf)']

        Inclusion Criteria:

          -  Histologically or cytologically confirmed neuroendocrine carcinoma of the
             gastrointestinal (GI) tract. Potential participants with unknown origin for the
             neuroendocrine carcinoma in which a gastroenteropancreatic origin is suspected (per
             pathologist or investigator discretion) will be eligible for the study.

          -  Tumors must have a Ki-67 index greater than 20% and/or >20 mitotic figures/10
             high-power fields.

          -  Must have metastatic disease.

          -  Must measurable disease, as defined by Response Evaluation Criteria in Solid Tumors
             (RECIST) 1.1.

          -  Any line of treatment (first line versus beyond first line).

          -  Age >18 years.

          -  Life expectancy of greater than 12 weeks.

          -  Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2.

          -  Must have adequate organ and marrow function.

          -  Ability to understand and the willingness to sign a written informed consent document.

        Exclusion Criteria:

          -  Have had chemotherapy or radiotherapy within 3 weeks prior to entering the study.

          -  Receiving any other investigational agents.

          -  Untreated brain or meningeal metastases.

          -  Prior treatment with 5-fluorouracil (5-FU), irinotecan or oxaliplatin.

          -  Pre-treatment peripheral neuropathy greater than grade 1 per the CTCAE, version 4.0.

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

          -  A secondary primary cancer (excluding baso/squamous cell carcinoma of skin) within 1
             year.

          -  Active viral hepatitis or autoimmune hepatitis. The work-up to confirm active
             hepatitis or autoimmune hepatitis will only be done if clinical suspicion based on
             investigator discretion.

          -  Potential participants with childbearing potential who are not willing to use adequate
             contraception precautions during the study and for 3 months after stopping study
             chemotherapy.
      