Inclusion Criteria

DISEASE CHARACTERISTICS:

- Histologically or cytologically confirmed pancreatic ductal adenocarcinoma

- Metastatic disease to distant sites, as documented by CT scan or MRI

- Patients with locally advanced disease are NOT eligible

- At least one site of disease measurable by RECIST 1.1 criteria; defined as lesions
that can be accurately measured in at least one dimension (longest diameter to be
recorded) as ≥ 2 cm with conventional techniques or as ≥ 1 cm with spiral CT scan

- No known CNS metastases or carcinomatous meningitis, as determined by physical
examination and/or imaging studies

- No suspected Gilbert syndrome or known homozygosity for the UGT1A1*28 allele (UGT1A1
genotyping is not required for enrollment on this study; however, patients known to
be homozygous for the UGT1A1*28 allele are excluded)

PATIENT CHARACTERISTICS:

- ECOG performance status 0 or 1

- Neutrophils ≥ 1,500/μL

- Platelet count ≥ 100,000/μL

- Creatinine ≤ 1.5 mg/dL OR creatinine clearance ≥ 60 mL/min

- Total bilirubin ≤ 1.5 x upper limit of normal (ULN)

- AST (SGOT) and ALT (SGPT) ≤ 2.5 x ULN

- INR ≤ 1.5

- Blood glucose level ≤ 160 mg/dL

- Patients with non-fasting blood glucose > 160 mg/dL must have a fasting blood
glucose ≤ 160 mg/dL to be eligible

- Patients with diabetes mellitus are allowed at the discretion of the treating
investigator, if blood sugars are felt to be under appropriate control

- Not pregnant or nursing

- Negative serum or urine pregnancy test

- No malignancy (other than non-melanoma skin cancer or carcinoma in situ of the
cervix) diagnosed within the past 3 years or any currently active malignancy

- A malignancy is considered not "active" if all anti-cancer therapies were
completed > 3 years before enrollment and there is no current evidence of
persistent disease

- No neurosensory or neuromotor toxicity ≥ grade 2

- No known allergy to platinum compounds or E. coli-derived products (e.g., filgrastim,
humulin, insulin, or L-asparaginase)

- No colonic or small bowel disorders with uncontrolled symptoms at baseline (for
example, > 3 watery or soft stools daily in patients without colostomy or ileostomy)

- Patients with colostomy or ileostomy can be enrolled at the discretion of the
investigator

- No history of stroke, unstable angina, myocardial infarction, or ventricular
arrhythmia requiring medication or mechanical control within 6 months of registration

- No HIV-positive patients with a prior history of AIDS-defining illness

- No HIV-positive patients with a CD4 count of < 450 cells/mm³ at any point prior
to study

- Anti-retroviral therapy must be discontinued during study treatment

- No known positivity for chronic infection with B virus (HBV)

PRIOR CONCURRENT THERAPY:

- Prior treatment with chemotherapy or radiotherapy for resected, locally advanced or
metastatic pancreatic cancer is NOT allowed

- No prior treatment with inhibitors of the insulin-like growth factor 1 receptor

- No prior treatment with radiotherapy to greater than 25% of bone marrow

- Palliative radiation therapy may NOT be administered while a subject is on the study

- No major surgery within 4 weeks of the start of study treatment

- Patients must have recovered from the side effects of any major surgery at the
start of study treatment

- Major surgery is defined as those surgeries that require general anesthesia

- Insertion of a vascular access device or endobiliary stent is NOT
considered major surgery

- No percutaneous biliary drain (endobiliary stents are allowed)

- Warfarin for INR goal > 1.5 is prohibited

- Patients on warfarin with INR goal of ≤ 1.5 are eligible

- Hormones or other chemotherapeutic agents may NOT be administered except for steroids
given for adrenal failure; hormones administered for non-disease-related conditions
(e.g., insulin for diabetes); and intermittent use of dexamethasone as an antiemetic
or for the prevention or treatment of ganitumab infusion reactions

- Patients receiving anti-retroviral therapy must discontinue such therapy while
receiving study treatment