Inclusion Criteria:
1. Has untreated (eg, no prior investigational therapies, chemotherapy, or radiation therapy), locally advanced or metastatic adenocarcinoma of the head, neck, uncinate process, or tail of the pancreas with a local or metastatic lesion that is amenable to biopsy before and after treatment. (Whenever possible, the before and after treatment biopsies should be from the same lesion.)
2. Is able and willing to undergo tumor biopsy before and after treatment. (A pretreatment biopsy may not be needed if tissue is available from a biopsy conducted within 28 days prior to screening that is adequate for the study assessments.)
3. Has Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1.
4. Is 18 to 75 years of age, inclusive
5. Has adequate organ function within 28 days of treatment initiation
6. For participants with exposure to prior agents associated with decreased left ventricular ejection fraction (LVEF) (e.g. anthracyclines), or if clinically warranted, a documented LVEF \> 45% using a standard echocardiogram (ECHO) or multigated acquisition (MUGA) scan test at Screening or within 60 days prior to Cycle 1 Day 1. ECHO or MUGA testing for other participants without relevant medical history or clinical symptoms can be performed if feasible.
7. Has oxygen saturation ≥ 92% on room air.
8. Is able to take an oral medication.
9. Has signed an Informed Consent Form (ICF) prior to the initiation of any study-specific procedures or treatment.
10. Is willing and able to adhere to the study visit schedule and other protocol requirements.
11. Women of childbearing potential (WOCBP) must have a negative pregnancy test at baseline. A woman must be menopausal for at least 12 months before she is considered not to be of reproductive potential.
12. Male and female patients of reproductive potential must agree to use an effective contraceptive method during participation in this study and for 6 months following the study.
Exclusion Criteria:
1. A female who is pregnant or breast-feeding.
2. Has other concurrent malignancies except for basal and squamous cell cancers of the skin and in-situ cervical cancer.
3. Has uncontrolled epilepsy, central nervous system diseases, or a history of mental disorder that is severe enough to hinder the ability of the patient to provide informed consent or that may influence the patient's compliance with the protocol in the judgments of the investigator.
4. Has an upper gastrointestinal obstruction, abnormal physiological function, or malabsorption syndrome that may affect the absorption of study medication.
5. Has required chronic corticosteroids, defined as \> 10 mg/day of prednisone or equivalent, or immunosuppressive therapy within the past 3 months. Patient requires treatment with DPP4 inhibitors (e.g. gliptins).
6. Has a premalignant hematologic disorder, eg, myelodysplastic syndrome.
7. Has a severe organ dysfunction or disease that might prevent completion of the treatment regimen, eg, cardiopulmonary diseases (New York Heart Association \[NYHA\] ≥ Class III, arrhythmia Lown III/IV, global respiratory insufficiency); ascites; acute pancreatitis; bleeding diathesis, coagulopathy, or need for full dose anticoagulation.
8. Has a chronic infectious disease, especially immune deficiency syndromes, eg, human immunodeficiency virus (HIV) infection, active tuberculosis within 12 months prior to potential study participation or suspected/active SARS-CoV-2 (Covid-19) infection.
9. Has a history of severe neurologic disorders, eg, cerebrovascular ischemia within the past year.
10. Has a history of prior deep venous thrombosis or pulmonary embolism within the past year.
11. Has serious medical, psychological, familial, sociological, or geographical conditions or circumstances potentially hampering compliance with the study protocol and follow-up.
12. QT interval corrected for heart rate using Bazett's formula (QTcB) \> 440 msec at Screening.
13. Patients with history of symptomatic orthostatic hypotension within 3 months prior to enrollment. Orthostatic hypotension is defined as a drop in systolic blood pressure (BP) of ≥ 20 mmHg or diastolic BP of ≥ 10 mmHg with assumption of an upright posture
