Pancrelipase in People With Pancreatic Ductal Adenocarcinoma (PDAC)

Inclusion Criteria: Histopathologic or cytologic diagnosis of pancreatic adenocarcinoma, or adenosquamous cancer, or any non-neuroendocrine primary pancreas variant, including acinar cancer. De novo or recurrent diagnosis of previously untreated stage IV PDAC with intent to receive FOLFIRINOX/mFOLFIRINOX. ECOG 0-2. No use of pancreatic enzyme replacement therapy within prior 2 weeks. Patients with biliary obstruction are eligible provided biliary stenting has or will occur before treatment with FOLFIRINOX. Ability to understand and the willingness to sign an informed consent document. Ability to swallow capsules. Age ≥18 years. Anticipated life expectancy of at least 6 months. Exclusion Criteria: Chronic illness associated with malabsorption (celiac disease, cystic fibrosis, chronic pancreatitis, Crohn's disease). Fibrosing colonopathy. Prior history of surgical resection of the pancreas or gastric bypass. History of allergic reactions attributed to compounds of similar chemical or biologic composition to Pancrelipase. Patients cannot receive radiation, IRE, or other localized therapy directed to the pancreas while on study.