This randomized phase II trial studies how well modified irinotecan hydrochloride, leucovorin calcium, fluorouracil (FOLFIRI) and veliparib as a second line of therapy work compared to FOLFIRI in treating patients with pancreatic cancer that has come back after a period of improvement (metastatic). Drugs used in chemotherapy, such as irinotecan hydrochloride, leucovorin calcium, and fluorouracil, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Veliparib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. It is not yet known whether modified FOLFIRI and veliparib as second line therapy is more effective than FOLFIRI alone in treating metastatic pancreatic cancer. Condition or disease Intervention/treatment Phase Metastatic Pancreatic Adenocarcinoma Recurrent Pancreatic Carcinoma Stage IV Pancreatic Cancer AJCC v6 and v7 Drug: Fluorouracil Drug: Irinotecan Hydrochloride Other: Laboratory Biomarker Analysis Drug: Leucovorin Calcium Drug: Veliparib Phase 2.

PRIMARY OBJECTIVES: I. To evaluate the overall survival (OS) of metastatic pancreatic cancer patients treated with fluorouracil, irinotecan (irinotecan hydrochloride), leucovorin (leucovorin calcium), (modified FOLFIRI) and ABT-888 (veliparib) compared to a control arm of fluorouracil, irinotecan, and leucovorin (FOLFIRI). SECONDARY OBJECTIVES: I.

To evaluate the frequency and severity of toxicity associated with each of the treatment arms in this patient population. To evaluate the progression-free survival (PFS) in each of the treatment arms in this patient population. To evaluate the overall response rate (confirmed and unconfirmed; complete response + partial response), disease control rate (confirmed and unconfirmed; complete response + partial response + stable disease), and duration of response in each of the treatment arms in this patient population. TERTIARY OBJECTIVES: I. To evaluate if breast cancer, early onset (BRCA)1 and BRCA2 mutations (somatic or germline) are associated with improved clinical outcomes (overall survival [OS], progression-free survival [PFS] and overall response rates [ORR]) in each treatment arm. To evaluate the impact of homologous recombination deficiency (HRD) score on clinical outcomes in each treatment arm.

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To evaluate the impact of genomic alterations identified by the BROCA-homologous recombinant (HR) assay, other than BRCA1/2, on clinical outcomes in each treatment arm. To bank tissue for future translational medicine studies. OUTLINE: Patients are randomized to 1 of 2 treatment arms. ARM I: Patients receive veliparib orally (PO) twice daily (BID) every 12 hours on days 1-7, irinotecan hydrochloride intravenously (IV) over 90-120 minutes on day 3, leucovorin calcium IV over 90-120 minutes on day 3, and fluorouracil IV over 46 hours on days 3-5. ARM II: Patients receive irinotecan hydrochloride IV over 90-120 minutes on day 1, leucovorin calcium IV over 90-120 minutes on day 1, and fluorouracil IV bolus over 15 minutes on days 1 and then over 46 hours on days 1-3.

In both arms, courses repeat every 14 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3 months for 3 years. Other Names: • Adinepar • Calcifolin • Calcium (6S)-Folinate • Calcium Folinate • Calcium Leucovorin • Calfolex • Calinat • Cehafolin • Citofolin • Citrec • citrovorum factor • Cromatonbic Folinico • Dalisol • Disintox • Divical • Ecofol • Emovis • Factor, Citrovorum • Flynoken A • Folaren • Folaxin • FOLI-cell • Foliben • Folidan • Folidar • Folinac • Folinate Calcium • folinic acid • Folinic Acid Calcium Salt Pentahydrate • Folinoral • Folinvit • Foliplus • Folix • Imo • Lederfolat • Lederfolin • Leucosar • leucovorin • Rescufolin • Rescuvolin • Tonofolin • Wellcovorin Drug: Veliparib. Other Names: • Adinepar • Calcifolin • Calcium (6S)-Folinate • Calcium Folinate • Calcium Leucovorin • Calfolex • Calinat • Cehafolin • Citofolin • Citrec • citrovorum factor • Cromatonbic Folinico • Dalisol • Disintox • Divical • Ecofol • Emovis • Factor, Citrovorum • Flynoken A • Folaren • Folaxin • FOLI-cell • Foliben • Folidan • Folidar • Folinac • Folinate Calcium • folinic acid • Folinic Acid Calcium Salt Pentahydrate • Folinoral • Folinvit • Foliplus • Folix • Imo • Lederfolat • Lederfolin • Leucosar • leucovorin • Rescufolin • Rescuvolin • Tonofolin • Wellcovorin. The impact of HRD positivity will be evaluated on clinical outcomes in each treatment arm.

The HRD score is the unweighted sum of loss of heterozygosity footprint, telomeric allelic imbalance, and large-scale state transitions measurements on a scale from 0-100. The HRD score threshold for positivity in this population will be estimated by applying receiver operating characteristic curves, classifying patients by overall disease response. • Genomic alterations identified by the BROCA-homologous recombinant (HR) assay [ Time Frame: Baseline ].

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