Hydroxychloroquine is approved for the treatment of non-cancerous illnesses such as rheumatoid arthritis and systemic lupus erythematous. Researchers in the laboratory have tested tumors from patients with pancreatic cancer and have discovered that they have certain pathways inside the cells that promote growth and survival of the tumor. Hydroxychloroquine may inactivate these pathways and results in the death of pancreatic cancer cells.

Primary Objective

• To determine the efficacy of single-agent hydroxychloroquine in patients with metastatic pancreatic cancer previously treated with one or two prior chemotherapy regimens as measured by progression-free survival at two months

Secondary Objectives

• To assess tumor response rate, biochemical response rate (i.e. decrease in serum CA19-9 by > 30%), and overall survival

Translational/Exploratory Objectives

• To investigate predictors of response to anti-autophagy therapy with hydroxychloroquine
• To explore the kinetics of in vivo autophagy inhibition using peripheral blood WBCs to monitor autophagic activity among patients receiving hydroxychloroquine

Inclusion Criteria:

• Histologically confirmed unresectable pancreatic adenocarcinoma that is metastatic to distant sites
• Measurable disease, defined as at least one lesion that can accurately be measured in at least one dimension
• Patients must have been treated with one or two previous lines of chemotherapy for metastatic disease with documented tumor progression or intolerance due to toxicity
• Minimum of two weeks since any major surgery, completion of radiation, or completion of all prior systemic anticancer therapy
• 18 years of age or older
• Life expectancy of greater than 12 weeks
• ECOG performance status of 0, 1 or 2
• Normal organ and marrow function as outlined in the protocol
• Patients must be able to swallow pills
• Women of child-bearing potential and men must agree to use adequate contraception prior to study entry and for the duration of study participation.

Exclusion Criteria:

• Participants who have had chemotherapy or radiotherapy within 2 weeks prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier.
• More than two previous chemotherapy regimens for the treatment of metastatic pancreatic cancer
• Uncontrolled brain or leptomeningeal metastases
• History of macular degeneration, visual field changes, retinal disease, or cataracts that would interfere with funduscopic eye examinations
• History of allergic reactions attributed to compounds of similar chemical or biologic composition to hydroxychloroquine
• Previous treatment with chloroquine or hydroxychloroquine for other indications, such as rheumatoid arthritis, SLE or malaria prophylaxis
• Prior treatment with any investigational drug within the preceding 4 weeks
• Impairment of gastrointestinal function or gastrointestinal disease that may significantly alter absorption of hydroxychloroquine. Patients who have undergone a Whipple procedure for localized pancreatic cancer are not excluded from enrollment
• History of non-compliance to medical regimens
• Known diagnosis of glucose-6-phosphate deficiency, porphyria or psoriasis
• Penicillamine use for Wilson's disease or any other indication
• Uncontrolled intercurrent illness including but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
• Pregnant or breastfeeding women
• Individuals with a history of a different malignancy are ineligible except for the following circumstances. Individuals with a history of other malignancies are eligible if they have been disease-free for at least 3-years and are deemed by the investigator to be at low risk for recurrence of that malignancy. Individuals with the following cancers are eligible if diagnosed and treated within the past three years: cervical cancer in situ, and basal cell or squamous cell carcinoma
• HIV-positive individuals on combination antiretroviral therapy

The analysis dataset is comprised of all enrolled patients.

Adverse events (AE) were assessed each cycle throughout treatment. Participants were followed for the duration of treatment, an average of 34 days for this study population.

Maximum grade toxicity by type for a patient over time including only treatment-related events (possible, probable or definite attribution) was first calculated with patients therefore appearing once for a given type of toxicity. Serious and Other AEs were defined as events of grades 3-5 and grades 1-2, respectively, based on CTCAEv3.