24BRO681 : Alternating Gnp and mFOLFIRINOX for BR-PDAC

Who May Qualify: - Age ≥ 18 years - Diagnosis of BR-PDAC. The resectability should be officially determined with surgical oncologists at the Dartmouth Cancer Center (DCC) GI multidisciplinary Tumor Board based on NCCN Guidelines Version 2.2024 Pancreatic Adenocarcinoma. - Patients must be able and willing to provide willing to sign a consent form. - Contrast-enhanced CT scan of the chest, abdomen, and pelvis performed within 45 days before registration. - ECOG Performance Status: 0-1. - Females of childbearing potential must have a negative pregnancy test done ≤ 14 days prior to study enrollment, and must agree to use a highly effective method of contraception throughout the course of protocol therapy. Who Should NOT Join This Trial: - Any prior receipt of chemotherapy or radiation therapy for PDAC. - Known DPYD poor metabolizer genotype. - Known BRCA1/2 or PALB2 mutations. If they are found to have BRCA1/2 or PALB2 mutation after inclusion to the trial, the participant will be taken off of protocol therapy (since platinum-containing therapy is preferred for these patients). - Any confirmed second malignancy that is likely to require systemic therapy during the study period, in the opinion of the enrolling investigator. - Any of the following baseline laboratory abnormalities: - Absolute neutrophil count (ANC) \< 2,500/mm3 - Platelet count \< 100,000/mm3 - Hemoglobin \< 7 g/dL - Creatinine \> 1.5 x upper limit of normal (ULN) - Total bilirubin \> 1.5 x ULN - AST/ALT \> 5 x ULN - Any peripheral sensory neuropathy that meaningfully impairs performance of instrumental activities of daily living, as evaluated by the enrolling investigator. - Patients who are unable to provide willing to sign a consent form. - Patients who are pregnant or breastfeeding. - Patients who are incarcerated. Always talk to your doctor about whether this trial is right for you.