Inclusion Criteria

Inclusion Criteria

1. Histological or cytological proven adenocarcinoma of the pancreas.

2. Locally advanced unresectable or metastatic disease not amenable to curative
treatment.

3. No prior treatment for advanced disease. Patient may have received adjuvant
treatment after curative resection. Patients who have received gemcitabine as part
of their adjuvant treatment need to have at least a 6 month progression free interval
after gemcitabine has been discontinued.

4. BRCA2 deleterious mutation, or genetic variant, suspected deleterious, by DNA
testing.

5. No prior treatment with MMC.

6. Age ≥18 years old.

7. ECOG PS 0-1.

8. Expected > 12 weeks survival.

9. Adequate renal, liver and bone-marrow function as determined by:

10. Ability to understand and willingness to sign a written informed consent.

11. Willingness of male and female subjects, who are not surgically sterile or
post-menopausal, to use reliable methods of birth control (oral contraceptives,
intrauterine devices, or barrier methods) for the duration of the study and for 30
days after the last dose of study medication.

Exclusion Criteria

1. Patients in whom histologic or cytologic diagnosis is not consistent with
adenocarcinoma including adenosquamous, islet cell, cystadenoma or
cystadenocarcinoma, carcinoid, small or large cell carcinoma or lymphoma.

2. Adenocarcinoma arising from a site other than pancreas (distal common bile duct,
ampulla of vater or periampullary duodenum).

3. Patients with known brain metastases should be excluded from this clinical trial
because of their poor prognosis and because they often develop progressive neurologic
dysfunction that would confound the evaluation of neurologic and other adverse
events.

4. Patients who have had any previous surgery, excluding minor procedures, dental work,
skin biopsy, etc. within 4 weeks of enrollment.

5. Uncontrolled medical conditions that could potentially increase the risk of
toxicities or complications of this therapy including immunodeficiency and chronic
treatment with immunosuppressors. Gastrointestinal tract disease resulting in an
inability to take oral medication or a requirement for IV alimentation, prior
surgical procedures affecting absorption, or active peptic ulcer disease.

6. Active infections.

7. History of concurrent malignancy or history of a second malignancy within the past 5
years, except squamous cell and basal cell carcinoma of the skin.

8. Participation in an investigational new drug trial within one month of starting
trial.

9. Unable to provide informed consent.

10. Concomitant use of phenytoin, carbamazepine, barbiturates, rifampin, phenobarbital or
St. Johns Wort.

11. Treatment with chemotherapy within 30 days of day 1 treatment.

12. Any unresolved chronic toxicity greater than CTCAE grade 2 from previous anticancer
therapy (except alopecia).

13. Pregnant women are excluded from this study because the effects of MMC on the
developing fetus are not known (FDA Pregnancy Category C). Because there is an
unknown but potential risk for adverse events in nursing infants secondary to
treatment of the mother with MMC, breast feeding should be discontinued if the mother
is treated with the drug.

14. Patients must not have clinically significant cardiovascular disease including
myocardial infarction (within 12 months prior to randomization), unstable angina,
grade II or greater peripheral vascular disease, uncontrolled congestive heart
failure or uncontrolled hypertension (SBP>170, DBP>95).